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Solanki SL, Salunke B, Gangakhedkar G, Ambulkar R, Kuberkar DV, Bhatt A. Acute kidney injury after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy - A systematic review. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108622. [PMID: 39216462 DOI: 10.1016/j.ejso.2024.108622] [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: 05/31/2024] [Revised: 08/05/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024]
Abstract
The use of nephrotoxic chemotherapeutic agents during hyperthermic intraperitoneal chemotherapy (HIPEC), carries the risk of postoperative acute kidney injury (AKI). The available evidence on this subject is sparse with variability in the reported incidence of AKI. In this systematic review, the aim was to analyse the incidence, risk factors, and preventive measures for AKI after cytoreductive surgery and HIPEC. A systematic literature search was conducted using the terms 'Acute kidney injury', 'Acute kidney failure', 'Acute renal failure', 'Acute renal impairment', 'HIPEC Surgery', 'Cytoreductive Surgery', 'Heated Chemotherapy' on PubMed, Scopus, clinical trial.gov, POPLINE and Google Scholar. Randomized controlled trials, cohort studies and observational studies published from January 2000-December 2020 were included. The systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42021247781). Data from 16 articles, which included 1622 patients, was included. The incidence AKI by any definition, was 23.36 %. The highest incidence of AKI (45.45 %) was reported after paclitaxel-HIPEC. The incidence of AKI after cisplatin-HIPEC was 34.7 %. Cisplatin HIPEC was the most common factor associated with AKI in 7/16 studies followed by pre-existing comorbidities and low intraoperative diuresis in 4 and 3 studies respectively. The perioperative use of sodium thiosulfate and amifostine led to a significant reduction in the incidence of AKI. The reported incidence of AKI after CRS-HIPEC is high. Identifying preoperative risk factors, optimising comorbidities, maintaining perioperative haemodynamic stability, perioperative use of sodium thiosulfate, maintaining adequate diuresis could reduce the incidence of AKI.
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Affiliation(s)
- Sohan Lal Solanki
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
| | - Bindiya Salunke
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Gauri Gangakhedkar
- Department of Anaesthesiology, Critical Care and Pain, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi-Mumbai, India
| | - Reshma Ambulkar
- Department of Anaesthesiology, Critical Care and Pain, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi-Mumbai, India
| | - Deepali V Kuberkar
- Department of Library Science, Digital Library, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Aditi Bhatt
- Department of Surgical Oncology, KD Hospital, Ahmedabad, India
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Cho M, Kim HS, Jung M, Hyung WJ. Perioperative intraperitoneal plus systemic chemotherapy and cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for gastric cancer: phase Ib/II single-arm prospective study. J Gastrointest Surg 2024; 28:1095-1103. [PMID: 38705369 DOI: 10.1016/j.gassur.2024.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 04/13/2024] [Accepted: 04/27/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND In gastric cancer, peritoneal metastasis is the most common form of metastasis and leads to dismal prognosis. We aimed to evaluate the safety and efficacy of combining perioperative intraperitoneal (IP) plus systemic chemotherapy, cytoreductive surgery (CRS), and hyperthermic intraperitoneal chemotherapy (HIPEC) for patients with gastric cancer with limited peritoneal metastasis or even after reducing peritoneal tumor burden by upfront IP chemotherapy. METHOD Patients were enrolled in phase Ib in a 3 + 3 dose escalation of IP paclitaxel plus a fixed dose of IP cisplatin and oral S-1. In phase II, patients were managed according to the peritoneal cancer index (PCI) by diagnostic laparoscopy. For patients with a PCI of >12, upfront IP and systemic chemotherapy were given. Patients with a PCI of ≤12 or reduced to ≤12 after upfront chemotherapy underwent CRS with HIPEC. The primary endpoints were safety and the recommended phase II dose (RP2D) confirmation for phase Ib and the 1-year overall survival rate for phase II. RESULTS The RP2D was defined as IP 175 mg/m2 paclitaxel and 60 mg/m2 cisplatin and oral 70 mg/m2/day S-1 for 14 days. A total of 22 patients were included. After CRS with HIPEC, there were no grade 3 or higher complications. The median hospital stay was 7 days (range, 6-11). The median overall and progression-free survival were 27.3 months (95% CI, 14.4 to not estimable) and 12.6 months (95% CI, 7.7-14.5), respectively. One-year overall and progression-free survival rates were 81.0% (95% CI, 65.8-99.6) and 54.5% (95% CI, 37.2-79.9), respectively. CONCLUSION A combination of IP plus systemic chemotherapy, CRS, and HIPEC was safe and resulted in good survival outcomes.
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Affiliation(s)
- Minah Cho
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea; Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea
| | - Hyo Song Kim
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea; Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Minkyu Jung
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea; Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea; Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea.
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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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Ghirardi V, Trozzi R, Scambia G, Fagotti A. Current and future trials about HIPEC in ovarian cancer. Bull Cancer 2024; 111:254-260. [PMID: 36863924 DOI: 10.1016/j.bulcan.2023.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/16/2022] [Accepted: 01/25/2023] [Indexed: 03/04/2023]
Abstract
Due to the typical peritoneal spread of the disease, together with cytoreductive surgery and adjuvant platinum-based chemotherapy, the role of hyperthermic intraperitoneal chemotherapy (HIPEC) is gainig more interest in advanced ovarian cancer (AOC) treatment. Indeed, the addition of hyperthemia seems to enhance the cytotoxic effect of chemotherapy directly delivered on peritoneal surface. So far, data on HIPEC administration during the primary debulking surgery (PDS) have been controversial. Indeed, despite flaws and biases, a survival advantage in a subgroup analysis of a prospective randomized trial of PDS+HIPEC treated patients was not demonstrated, whilst positive results are coming from a large retrospective cohort of patients treated with HIPEC after upfront surgery. In this setting, larger prospective data from an ongoing trial are expected by 2026. Contrariously, the addition of HIPEC with cisplatin 100mg/m2 at the time of interval debulking surgery (IDS) has shown to prolong both progression-free and overall survival by prospective randomized data, despite few controversies on the methodology and the results of this trial arose among the experts. So far, available high quality data on HIPEC treatment after surgery for disease recurrence failed to demonstrate a survival benefit in this group of patients, however few trials are ongoing and results are awaited. With this article, we aim to discuss the main findings of available evidence and the objectives of ongoing trials on the addition of HIPEC to various timing of cytoreductive surgery in AOC, also in view of the development of precision medicine and targeted therapies in AOC treatment.
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Affiliation(s)
- Valentina Ghirardi
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Universita' Cattolica del Sacro Cuore, Rome, Italy.
| | - Rita Trozzi
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Scambia
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Anna Fagotti
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Universita' Cattolica del Sacro Cuore, Rome, Italy
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Navarro Santana B, Garcia-Torralba E, Viveros-Carreño D, Rodriguez J, Pareja R, Martin A, Forte S, Krause KJ, González-Martín JM, Ramirez PT. Complications of HIPEC for ovarian cancer surgery: evaluation over two time periods. Int J Gynecol Cancer 2024; 34:1-9. [PMID: 37669829 DOI: 10.1136/ijgc-2023-004658] [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] [Indexed: 09/07/2023] Open
Abstract
OBJECTIVE Cytoreductive surgery in conjunction with hyperthermic intraperitoneal chemotherapy (HIPEC) is being explored in the upfront, interval, and recurrent setting in patients with ovarian cancer. The objective of this systematic review was to assess the rate of complications associated with HIPEC in epithelial ovarian cancer surgery over two time periods. METHODS This study was registered in PROSPERO (CRD42022328928). A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Ovid/Medline, Ovid/Embase, Web of Science, Scopus, and Cochrane Central Register of Controlled Trials were searched from January 2004 to April 2022. We included studies reporting on patients with advanced primary or recurrent epithelial ovarian cancer who underwent cytoreductive surgery and HIPEC. We evaluated two different time periods: 2004-2013 and 2014-2022. A random-effects meta-analysis was used to produce an overall summary. Subgroup analyses were planned according to recruited period for each specific complication type. Heterogeneity was assessed using the I2 statistic. RESULTS A total of 4928 patients were included from 69 studies for this systematic review; 19 published from 2004-2013, and 50 published from 2014-2022. No significant differences were found between the two time periods in terms of blood transfusions (33% vs 51%; p=0.46; I2=95%) overall gastrointestinal complications (15% vs 21%; p=0.36; I2=98%), infectious diseases (16% vs 13%; p=0.62; I2=93%), overall respiratory complications (12% vs 12%; p=0.88; I2=91%), overall urinary complications (6% vs 12%; p=0.06; I2=94%), or thromboembolic events (5% vs 3%; p=0.25; I2=63%). Also, no differences were found in intensive care unit (ICU) admissions (89% vs 28%; p=0.06; I2=99%), reoperations (8% vs 7%; p=0.50; I2=37%), or deaths (3% vs 3%; p=0.77; I2=57%). CONCLUSIONS Our review showed that overall complications have not changed over time for patients undergoing HIPEC in the setting of primary or recurrent ovarian cancer. There was no decrease in the rates of ICU admissions, reoperations, or deaths.
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Affiliation(s)
| | | | - David Viveros-Carreño
- Gynecologic Oncology, Instituto Nacional de Cancerologia, Bogota, Colombia
- Gynecologic Oncology, Clínica Universitaria Colombia and Centro de Tratamiento e Investigación sobre Cáncer Luis Carlos Sarmiento Angulo-CTIC, Bogotá, Colombia
| | | | - Rene Pareja
- Gynecologic Oncology, Instituto Nacional de Cancerologia, Bogota, Colombia
| | - Alicia Martin
- Insular University Hospital of Gran Canaria, Las Palmas de Gran Canaria, Canarias, Spain
| | - Sara Forte
- Azienda USL Toscana centro, Prato, Italy
| | - Kate J Krause
- The University of Texas MD Anderson Cancer Center Research Medical Library, Houston, Texas, USA
| | - J M González-Martín
- Insular University Hospital of Gran Canaria, Las Palmas de Gran Canaria, Canarias, Spain
| | - Pedro T Ramirez
- Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, Texas, USA
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Bhatt A, Glehen O, Zivanovic O, Brennan D, Nadeau C, Van Driel W, Bakrin N. The 2022 PSOGI International Consensus on HIPEC Regimens for Peritoneal Malignancies: Epithelial Ovarian Cancer. Ann Surg Oncol 2023; 30:8115-8137. [PMID: 37561343 DOI: 10.1245/s10434-023-13932-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 06/27/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND AND AIM We report the results of an international consensus on hyperthermic intraperitoneal chemotherapy (HIPEC) regimens for epithelial ovarian cancer (EOC) performed with the following goals: To define the indications for HIPEC To identify the most suitable HIPEC regimens for each indication in EOC To identify areas of future research on HIPEC To provide recommendations for some aspects of perioperative care for HIPEC METHODS: The Delphi technique was used with two rounds of voting. There were three categories of questions: evidence-based recommendations [using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) system with the patient, intervention, comparator, and outcome (PICO) method], an opinion survey, and research recommendations. RESULTS Seventy-three (67.5%) of 108 invited experts responded in round I, and 68 (62.9%) in round II. Consensus was achieved for 34/38 (94.7%) questions. However, a strong positive consensus that would lead to inclusion in routine care was reached for only 6/38 (15.7%) questions. HIPEC in addition to interval cytoreductive surgery (CRS) received a strong positive recommendation that merits inclusion in routine care. Single-agent cisplatin was the only drug recommended for routine care, and OVHIPEC-1 was the most preferred regimen. The panel recommended performing HIPEC for a minimum of 60 min with a recommended minimum intraabdominal temperature of 41°C. Nephroprotection with sodium thiosulfate should be used for cisplatin HIPEC. CONCLUSIONS The results of this consensus should guide clinical decisions on indications of HIPEC and the choice and various parameters of HIPEC regimens and could fill current knowledge gaps. These outcomes should be the basis for designing future clinical trials on HIPEC in EOC.
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Affiliation(s)
- Aditi Bhatt
- Department of Surgical Oncology, KD Hospital, Ahmedabad, India.
| | - Olivier Glehen
- Department of Surgical Oncology, Centre Hospitalier, Lyon-sud, Lyon, France
| | - Oliver Zivanovic
- Department of Gynecological Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Donal Brennan
- UCD Gynaecological Oncology Group, UCD School of Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Cedric Nadeau
- Department of Gynecological Oncology, CHU de Poitiers, Poitiers, Cedex, France
| | - Willemien Van Driel
- Department of Gynecological Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Naoual Bakrin
- Department of Surgical Oncology, Centre Hospitalier, Lyon-sud, Lyon, France
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Llueca A, Ibañez MV, Cascales P, Gil-Moreno A, Bebia V, Ponce J, Fernandez S, Arjona-Sanchez A, Muruzabal JC, Veiga N, Diaz-Feijoo B, Celada C, Gilabert-Estelles J, Aghababyan C, Lacueva J, Calero A, Segura JJ, Maiocchi K, Llorca S, Villarin A, Climent MT, Delgado K, Serra A, Gomez-Quiles L, Llueca M. Neoadjuvant Chemotherapy plus Interval Cytoreductive Surgery with or without Hyperthermic Intraperitoneal Chemotherapy (NIHIPEC) in the Treatment of Advanced Ovarian Cancer: A Multicentric Propensity Score Study. Cancers (Basel) 2023; 15:4271. [PMID: 37686547 PMCID: PMC10486645 DOI: 10.3390/cancers15174271] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 08/21/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
INTRODUCTION Epithelial ovarian cancer (EOC) is primarily confined to the peritoneal cavity. When primary complete surgery is not possible, neoadjuvant chemotherapy (NACT) is provided; however, the peritoneum-plasma barrier hinders the drug effect. The intraperitoneal administration of chemotherapy could eliminate residual microscopic peritoneal tumor cells and increase this effect by hyperthermia. Intraperitoneal hyperthermic chemotherapy (HIPEC) after interval cytoreductive surgery could improve outcomes in terms of disease-free survival (DFS) and overall survival (OS). MATERIALS AND METHODS A multicenter, retrospective observational study of advanced EOC patients who underwent interval cytoreductive surgery alone (CRSnoH) or interval cytoreductive surgery plus HIPEC (CRSH) was carried out in Spain between 07/2012 and 12/2021. A total of 515 patients were selected. Progression-free survival (PFS) and OS analyses were performed. The series of patients who underwent CRSH or CRSnoH was balanced regarding the risk factors using a statistical analysis technique called propensity score matching. RESULTS A total of 170 patients were included in each subgroup. The complete surgery rate was similar in both groups (79.4% vs. 84.7%). The median PFS times were 16 and 13 months in the CRSH and CRSnoH groups, respectively (Hazard ratio (HR) 0.74; 95% CI, 0.58-0.94; p = 0.031). The median OS times were 56 and 50 months in the CRSH and CRSnoH groups, respectively (HR, 0.88; 95% CI, 0.64-1.20; p = 0.44). There was no increase in complications in the CRSH group. CONCLUSION The addition of HIPEC after interval cytoreductive surgery is safe and increases DFS in advanced EOC patients.
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Affiliation(s)
- Antoni Llueca
- Multidisciplinary Unit of Abdominopelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, 12004 Castellon, Spain; (K.M.); (S.L.); (A.V.); (M.T.C.); (K.D.); (A.S.); (L.G.-Q.)
- Oncological Surgery Research Group (OSRG), Department of Medicine, University Jaume I (UJI), 12071 Castellon, Spain
| | | | - Pedro Cascales
- Department of General Surgery, Hospital Universitario Virgen de la Arrixaca, El Palmar, 30120 Murcia, Spain;
| | - Antonio Gil-Moreno
- Gynecologic Oncology Unit, Department of Gynecology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (A.G.-M.); (V.B.)
| | - Vicente Bebia
- Gynecologic Oncology Unit, Department of Gynecology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (A.G.-M.); (V.B.)
| | - Jordi Ponce
- Department of Gynecology, University Hospital of Bellvitge, 08907 Barcelona, Spain; (J.P.); (S.F.)
| | - Sergi Fernandez
- Department of Gynecology, University Hospital of Bellvitge, 08907 Barcelona, Spain; (J.P.); (S.F.)
| | - Alvaro Arjona-Sanchez
- Unit of Surgical Oncology and Pancreatic Surgery, University Hospital Reina Sofia, 14004 Cordoba, Spain;
| | - Juan Carlos Muruzabal
- Department of Gynecologic Oncology, Complejo Hospitalario de Navarra, 31008 Pamplona, Spain; (J.C.M.); (N.V.)
| | - Nadia Veiga
- Department of Gynecologic Oncology, Complejo Hospitalario de Navarra, 31008 Pamplona, Spain; (J.C.M.); (N.V.)
| | - Berta Diaz-Feijoo
- Gynecologic Oncology Unit, Clinic Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain; (B.D.-F.); (C.C.)
| | - Cristina Celada
- Gynecologic Oncology Unit, Clinic Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain; (B.D.-F.); (C.C.)
| | - Juan Gilabert-Estelles
- Department of Obstetrics and Gynecology, University General Hospital of Valencia, 46014 Valencia, Spain; (J.G.-E.); (C.A.)
| | - Cristina Aghababyan
- Department of Obstetrics and Gynecology, University General Hospital of Valencia, 46014 Valencia, Spain; (J.G.-E.); (C.A.)
| | - Javier Lacueva
- Unit of Peritoneal Carcinomatosis, Department of General Surgery, University General Hospital of Elche, 03203 Elche, Spain; (J.L.); (A.C.)
| | - Alicia Calero
- Unit of Peritoneal Carcinomatosis, Department of General Surgery, University General Hospital of Elche, 03203 Elche, Spain; (J.L.); (A.C.)
| | - Juan Jose Segura
- Hepatobiliopancreatic Surgery and Peritoneal Oncology Surgery Unit, General Surgery and Digestive System Department, Son Espases University Hospital, 07120 Palma de Mallorca, Spain;
| | - Karina Maiocchi
- Multidisciplinary Unit of Abdominopelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, 12004 Castellon, Spain; (K.M.); (S.L.); (A.V.); (M.T.C.); (K.D.); (A.S.); (L.G.-Q.)
- Department of General Surgery, University General Hospital of Castellon, 12004 Castellon, Spain
| | - Sara Llorca
- Multidisciplinary Unit of Abdominopelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, 12004 Castellon, Spain; (K.M.); (S.L.); (A.V.); (M.T.C.); (K.D.); (A.S.); (L.G.-Q.)
- Department of General Surgery, University General Hospital of Castellon, 12004 Castellon, Spain
| | - Alvaro Villarin
- Multidisciplinary Unit of Abdominopelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, 12004 Castellon, Spain; (K.M.); (S.L.); (A.V.); (M.T.C.); (K.D.); (A.S.); (L.G.-Q.)
- Department of General Surgery, University General Hospital of Castellon, 12004 Castellon, Spain
| | - Maria Teresa Climent
- Multidisciplinary Unit of Abdominopelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, 12004 Castellon, Spain; (K.M.); (S.L.); (A.V.); (M.T.C.); (K.D.); (A.S.); (L.G.-Q.)
- Oncological Surgery Research Group (OSRG), Department of Medicine, University Jaume I (UJI), 12071 Castellon, Spain
| | - Katty Delgado
- Multidisciplinary Unit of Abdominopelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, 12004 Castellon, Spain; (K.M.); (S.L.); (A.V.); (M.T.C.); (K.D.); (A.S.); (L.G.-Q.)
- Oncological Surgery Research Group (OSRG), Department of Medicine, University Jaume I (UJI), 12071 Castellon, Spain
| | - Anna Serra
- Multidisciplinary Unit of Abdominopelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, 12004 Castellon, Spain; (K.M.); (S.L.); (A.V.); (M.T.C.); (K.D.); (A.S.); (L.G.-Q.)
- Oncological Surgery Research Group (OSRG), Department of Medicine, University Jaume I (UJI), 12071 Castellon, Spain
| | - Luis Gomez-Quiles
- Multidisciplinary Unit of Abdominopelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, 12004 Castellon, Spain; (K.M.); (S.L.); (A.V.); (M.T.C.); (K.D.); (A.S.); (L.G.-Q.)
- Department of General Surgery, University General Hospital of Castellon, 12004 Castellon, Spain
| | - Maria Llueca
- Department of Obstetrics and Gynecology, Joan XXIII University Hospital of Tarragona, 43005 Tarragona, Spain;
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Llueca M, Ibañez MV, Climent MT, Serra A, Llueca A. Effectiveness of Hyperthermic Intraperitoneal Chemotherapy Associated with Cytoreductive Surgery in the Treatment of Advanced Ovarian Cancer: Systematic Review and Meta-Analysis. J Pers Med 2023; 13:jpm13020258. [PMID: 36836494 PMCID: PMC9960788 DOI: 10.3390/jpm13020258] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/21/2023] [Accepted: 01/27/2023] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE The use of hyperthermic intraperitoneal chemotherapy (HIPEC) as a treatment for epithelial ovarian cancer remains controversial. Our study aims to analyze the overall survival and disease-free survival for the use of HIPEC as a treatment for advanced epithelial ovarian cancer after neoadjuvant chemotherapy. METHODS A systematic review and meta-analysis was carried out using PubMed, Cochrane, Web of Science, and ClinicalTrials.gov. A total of six studies were used, comprising a total of 674 patients. RESULTS The results of our meta-analysis of all studies analyzed together (observational and randomized controlled trials (RCT)) did not achieve significant results. Contrary to the OS (HR = 0.56, 95% IC = 0.33-0.95, p = 0.03) and DFS (HR = 0.61, 95% IC = 0.43-0.86, p < 0.01) of the RCT analyzed separately, a clear impact on survival was suggested. The subgroup analysis showed that studies making use of higher temperatures (≥42 °C) for a shorter period of time (≤60 min) achieved better results for both OS and DFS, as well as the use of cisplatin as the form of chemotherapy in HIPEC. Moreover, the use of HIPEC did not increase high-grade complications. CONCLUSIONS The addition of HIPEC to cytoreductive surgery demonstrates an improvement in OS and DFS for patients with epithelial ovarian cancer in advanced stages, without an increase in the number of complications. The use of cisplatin as chemotherapy in HIPEC obtained better results.
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Affiliation(s)
- Maria Llueca
- Department of Medicine, University CEU-Cardenal Herrera, 12006 Castellon, Spain
| | | | - Maria Teresa Climent
- Multidisciplinary Unit of Abdominopelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, 12006 Castellon, Spain
- Oncological Surgery Research Group (OSRG), Department of Medicine, University Jaume I (UJI), 12006 Castellon, Spain
| | - Anna Serra
- Multidisciplinary Unit of Abdominopelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, 12006 Castellon, Spain
- Oncological Surgery Research Group (OSRG), Department of Medicine, University Jaume I (UJI), 12006 Castellon, Spain
| | - Antoni Llueca
- Multidisciplinary Unit of Abdominopelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, 12006 Castellon, Spain
- Oncological Surgery Research Group (OSRG), Department of Medicine, University Jaume I (UJI), 12006 Castellon, Spain
- Correspondence:
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Lee YJ, Seon KE, Jung DC, Lee JY, Nam EJ, Kim SW, Kim S, Kim YT. Interval debulking surgery with or without hyperthermic intraperitoneal chemotherapy in advanced-stage ovarian cancer: Single-institution cohort study. Front Oncol 2022; 12:936099. [PMID: 35965567 PMCID: PMC9367968 DOI: 10.3389/fonc.2022.936099] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
To evaluate the additive effects of hyperthermic intraperitoneal chemotherapy (HIPEC) to interval debulking surgery (IDS) in patients with advanced-stage ovarian cancer. From January 2015 to February 2019, 123 patients with stages IIIC-IV ovarian cancer were treated with neoadjuvant chemotherapy (NAC) followed by IDS with optimal cytoreduction. Forty-three patients received IDS with HIPEC and 80 patients had IDS without HIPEC. The median follow-up period was 34.4 months. No differences in baseline characteristics in patients were found between the two groups. The IDS with HIPEC group had fewer median cycles of chemotherapy (P = 0.002) than the IDS group. The IDS with HIPEC group had a higher rate of high surgical complexity score (P = 0.032) and higher rate of complete resection (P = 0.041) compared to the IDS group. The times to start adjuvant chemotherapy were longer in the IDS with HIPEC group compared to the IDS group (P < 0.001). Postoperative grade 3 or 4 complications were similar in the two groups (P = 0.237). Kaplan-Meier analysis showed that HIPEC with the IDS group had better progression-free survival (PFS) (P = 0.010), while there was no difference in overall survival between the two groups (P = 0.142). In the multivariate analysis, HIPEC was significantly associated with better PFS (HR, 0.60; 95% CI, 0.39 - 0.93). The addition of HIPEC to IDS resulted in longer PFS than IDS without HIPEC not affecting the safety profile. Further research is needed to evaluate the true place of HIPEC in the era of targeted treatments.
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Affiliation(s)
- Yong Jae Lee
- Department of Obstetrics and Gynecology, Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Ki Eun Seon
- Department of Obstetrics and Gynecology, Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Dae Chul Jung
- Department of Radiology, Yonsei Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Jung-Yun Lee
- Department of Obstetrics and Gynecology, Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, South Korea
- *Correspondence: Jung-Yun Lee,
| | - Eun Ji Nam
- Department of Obstetrics and Gynecology, Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Sang Wun Kim
- Department of Obstetrics and Gynecology, Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Sunghoon Kim
- Department of Obstetrics and Gynecology, Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Young Tae Kim
- Department of Obstetrics and Gynecology, Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, South Korea
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Bai L, Pfeifer T, Gross W, De La Torre C, Zhao S, Liu L, Schaefer M, Herr I. Establishment of Tumor Treating Fields Combined With Mild Hyperthermia as Novel Supporting Therapy for Pancreatic Cancer. Front Oncol 2021; 11:738801. [PMID: 34804927 PMCID: PMC8597267 DOI: 10.3389/fonc.2021.738801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 10/18/2021] [Indexed: 12/22/2022] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is a highly malignant tumor with poor prognosis and limited therapeutic options. Alternating electrical fields with low intensity called "Tumor Treating Fields" (TTFields) are a new, non-invasive approach with almost no side effects and phase 3 trials are ongoing in advanced PDAC. We evaluated TTFields in combination with mild hyperthermia. Three established human PDAC cell lines and an immortalized pancreatic duct cell line were treated with TTFields and hyperthermia at 38.5°C, followed by microscopy, assays for MTT, migration, colony and sphere formation, RT-qPCR, FACS, Western blot, microarray and bioinformatics, and in silico analysis using the online databases GSEA, KEGG, Cytoscape-String, and Kaplan-Meier Plotter. Whereas TTFields and hyperthermia alone had weak effects, their combination strongly inhibited the viability of malignant, but not those of nonmalignant cells. Progression features and the cell cycle were impaired, and autophagy was induced. The identified target genes were key players in autophagy, the cell cycle and DNA repair. The expression profiles of part of these target genes were significantly involved in the survival of PDAC patients. In conclusion, the combination of TTFields with mild hyperthermia results in greater efficacy without increased toxicity and could be easily clinically approved as supporting therapy.
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Affiliation(s)
- Liping Bai
- Molecular OncoSurgery, Section Surgical Research, Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Tobias Pfeifer
- Molecular OncoSurgery, Section Surgical Research, Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Wolfgang Gross
- Molecular OncoSurgery, Section Surgical Research, Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Carolina De La Torre
- Medical Research Center, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Shuyang Zhao
- Department of Hematology, Oncology and Rheumatology, Internal Medicine V, University Hospital of Heidelberg, Heidelberg, Germany
| | - Li Liu
- Molecular OncoSurgery, Section Surgical Research, Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Michael Schaefer
- Molecular OncoSurgery, Section Surgical Research, Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Ingrid Herr
- Molecular OncoSurgery, Section Surgical Research, Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
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Hyperthermic intraperitoneal chemotherapy for recurrent epithelial ovarian cancer. Biomed J 2021; 45:821-827. [PMID: 34656802 PMCID: PMC9661499 DOI: 10.1016/j.bj.2021.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 08/04/2021] [Accepted: 10/05/2021] [Indexed: 01/17/2023] Open
Abstract
Background To investigate outcomes and morbidity of patients undergoing secondary cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in recurrent ovarian cancer. Materials and methods Between April 2014 and January 2019, a total of 51 recurrent ovarian cancer patients receiving secondary CRS and HIPEC were retrospectively reviewed. Results Among the 51 patients, median peritoneal cancer index score was 13 (range 3–34), and completeness of cytoreduction (CC) score of 0/1 was achieved in 41 patients (78.8%). Regimen of HIPEC included cisplatin and paclitaxel in 39 (75%) cases. The median follow-up duration of survivors was 20.2 months. Sixteen (30.8%) patients remained free of recurrence after HIPEC. The median progression-free survival (PFS) and overall survival (OS) were 11.8 months and 34.5 months respectively. Multivariate analysis showed previous chemotherapy <2 lines (HR 0.24, 0.11–0.52; p = 0.001), chemotherapy-free interval ≥6 months (HR 0.19, 0.09–0.37; p < 0.001) and CA125 < 35 U/mL before HIPEC (HR 0.133, 0.021–0.0832; p = 0.031) were good prognostic factors for PFS. CC0/1 was not significant in multivariate analysis. The most common grade 3/4 toxicity was anemia (17.3%), pleural effusion (11.5%) and renal insufficiency (5.7%). Patients with age ≥50, peritoneal carcinomatosis index (PCI) ≥ 11, operation time ≥10 h and diaphragm surgery had significantly higher incidence of pleural effusion. Conclusions The current study showed adding HIPEC to secondary CRS might prolong PFS especially in patients with previous chemotherapy <2 lines, chemotherapy-free interval ≥6 months and CA125 < 35 U/mL before HIPEC.
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Burg L, Timmermans M, van der Aa M, Boll D, Rovers K, de Hingh I, van Altena A. Incidence and predictors of peritoneal metastases of gynecological origin: a population-based study in the Netherlands. J Gynecol Oncol 2021; 31:e58. [PMID: 32808491 PMCID: PMC7440978 DOI: 10.3802/jgo.2020.31.e58] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/19/2020] [Accepted: 03/22/2020] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE Peritoneal metastases (PM) are a challenge in gynecological cancers, but its appearance has never been described in a population-based study. Therefore, we describe the incidence of PM and identify predictors that increase the probability of peritoneal spread. METHODS All ovarian, endometrial and cervical cancer patients diagnosed in the Netherlands between 1989 and 2015 were identified from the Netherlands Cancer Registry and stratified for PM. Crude and age-adjusted incidence over time was calculated. Independent predictors for PM were identified using uni- and multivariable analyses. RESULTS The 94,981 patients were diagnosed with ovarian, endometrial or cervical cancer and respectively 61%, 2% and 1% presented with PM. Predictors for PM in ovarian cancer were: age between 50 and 74 years (odds ratio [OR]=1.19; 95% confidence interval [CI]=1.08-1.32), other distant metastases (OR=1.25; 95% CI=1.10-1.41), poor differentiation grade (OR=2.00; 95% CI=1.73-2.32) and serous histology. Predictors in endometrial cancer were lymph node metastases (OR=2.32; 95% CI=1.65-3.26), other distant metastases (OR=1.38; 95% CI=1.08-1.77), high-grade tumors (OR=1.95; 95% CI=1.38-2.76) and clear cell (OR=1.49; 95% CI=1.04-2.13) or serous histology (OR=2.71; 95% CI=2.15-3.42). In cervical cancer, the risk is higher in adenocarcinoma than in squamous cell carcinoma (OR=4.92; 95% CI=3.11-7.79). CONCLUSION PM are frequently seen in patients with ovarian cancer. In endometrial and cervical cancer PM are rare. Histological subtype was the strongest predictive factor for PM in all 3 cancers. Better understanding of predictive factors for PM and thus the biological behavior is of paramount importance.
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Affiliation(s)
- Lara Burg
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Maite Timmermans
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Department of Obstetrics and Gynecology, Maastricht University Medical Centre, Maastricht, The Netherlands.,GROW, School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - Maaike van der Aa
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Dorry Boll
- Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, The Netherlands
| | - Koen Rovers
- Department of Surgical Oncology, Catharina Cancer Hospital, Eindhoven, The Netherlands
| | - Ignace de Hingh
- Department of Surgical Oncology, Catharina Cancer Hospital, Eindhoven, The Netherlands
| | - Anne van Altena
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
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Cytoreductive Surgery plus Hyperthermic Intraperitoneal Chemotherapy Improves Survival with Acceptable Safety for Advanced Ovarian Cancer: A Clinical Study of 100 Patients. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5533134. [PMID: 34258265 PMCID: PMC8245244 DOI: 10.1155/2021/5533134] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/28/2021] [Accepted: 05/17/2021] [Indexed: 11/17/2022]
Abstract
Background The mainstay of treatment for advanced ovarian cancer is debulking surgery followed by chemotherapy that includes carboplatin and paclitaxel, but the prognosis is poor. This study is aimed at evaluating the efficacy and safety of cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (CRS+HIPEC) as first-line surgical treatment in patients with advanced ovarian cancer (AOC). Methods FIGO stage III/IV AOC patients underwent CRS+HIPEC as first-line surgical treatment at our center from December 2007 to January 2020. The primary endpoint was survival, and the secondary endpoint was safety. Results Among 100 patients, the median Karnofsky performance status (KPS) score was 80 (50-100), median peritoneal cancer index (PCI) was 19 (1-39), median completeness of cytoreduction (CC) score was 1 (0-3), number of organ regions removed was 4 (3-9), number of peritoneal regions removed was 4 (1-9), and number of anastomoses was 1 (0-4). The median follow-up was 36.8 months; 75 (75.0%) patients were still alive, and 25 (25.0%) had died. The median overall survival (mOS) was 87.6 (95% CI: 72.1-103.0) months, and the 1-, 2-, 3-, 4-, and 5-year survival rates were 94.1%, 77.2%, 68.2%, 64.2%, and 64.2%, respectively. Univariate analysis showed that better mOS correlated with an age ≤, KPS ≥ 80, ascites ≤ 1000 ml, PCI < 19, and CC score 0-1. Multivariate Cox analysis showed that CC was an independent factor for OS; patients who underwent CRS with a CC score 0-1 had a mPFS of 67.8 (95% CI: 48.3-87.4) months. The perioperative serious adverse event and morbidity rates were 4.0% and 2.0%, respectively. Conclusions CRS+HIPEC improves survival for AOC patients with acceptable safety at experienced high-volume centers. Stringent patient selection and complete CRS are key factors for better survival.
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Iavazzo C, Fotiou A, Psomiadou V, Lekka S, Katsanos D, Spiliotis J. Small Bowel PCI Score as a Prognostic Factor of Ovarian Cancer Patients Undergoing Cytoreductive Surgery (CRS) with Hyperthermic Intraperitoneal Chemotherapy (HIPEC), a Retrospective Analysis of 130 Patients. Indian J Surg Oncol 2021; 12:258-265. [PMID: 34295068 PMCID: PMC8272783 DOI: 10.1007/s13193-021-01304-w] [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: 06/10/2020] [Accepted: 02/25/2021] [Indexed: 12/29/2022] Open
Abstract
Ovarian cancer is the leading cause of death among gynecologic malignancies. Combining cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) can benefit patients with advanced ovarian cancer. We evaluate the role of small bowel peritoneal cancer index (sb-PCI) score as a prognostic factor. We retrospectively analyzed characteristics and clinical outcomes of patients that underwent intermediate cytoreductive surgery combined with HIPEC after neoadjuvant chemotherapy and patient's characteristics underwent debulking surgery plus HIPEC for recurrence disease. One hundred thirty patients were included. Eighty-five of them (65.4%) were treated for recurrent ovarian cancer, while 45 (34.6%) underwent intermediate cytoreductive surgery after neoadjuvant chemotherapy with a mean age of 52 years. Mean intraoperative peritoneal cancer index (PCI) was 11.84 with a mean sb-PCI score of 5.57. Univariate analysis revealed that PCI, sb-PCI, and completeness of cytoreduction (CC) were parameters that correlated significantly with overall survival, while after multivariate analysis sb-PCI and CC were identified as independent prognostic factors of survival. A statistically significant correlation between sb-PCI score and overall survival of patients with advanced ovarian cancer was revealed. Further larger future studies are required to confirm our conclusion in order to change the treatment of advanced ovarian cancer patients.
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Affiliation(s)
- Christos Iavazzo
- Department of Gynecological Oncology, Metaxa Cancer Hospital, 51, Botasi Str., Piraeus, Greece
| | - Alexandros Fotiou
- Department of Gynecological Oncology, Metaxa Cancer Hospital, 51, Botasi Str., Piraeus, Greece
| | - Victoria Psomiadou
- Department of Gynecological Oncology, Metaxa Cancer Hospital, 51, Botasi Str., Piraeus, Greece
| | - Sofia Lekka
- Department of Gynecological Oncology, Metaxa Cancer Hospital, 51, Botasi Str., Piraeus, Greece
| | | | - John Spiliotis
- Department of Surgical Oncology and HIPEC, Athens Medical Centre, Athens, Greece
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The addition of sodium thiosulphate to hyperthermic intraperitoneal chemotherapy with cisplatin in ovarian cancer. Gynecol Oncol Rep 2021; 37:100796. [PMID: 34141848 PMCID: PMC8185237 DOI: 10.1016/j.gore.2021.100796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 12/28/2022] Open
Abstract
Cisplatin chemotherapy is highly nephrotoxic and is a dose limiting side effect. The OVIHIPEC-1 trial employed sodium thiosulphate (ST) as a renal protectant. We analyse the implementation of HIPEC for EOC in a peritoneal malignancy centre. One acute kidney injury (AKI) event was noted when ST was not used with HIPEC. No AKI was observed when sodium thiosulphate was used with cisplatin at 100 mg/m2.
Cisplatin based hyperthermic intraperitoneal chemotherapy (HIPEC) has been shown to prolong recurrence free and overall survival of women with ovarian cancer who have responded to neoadjuvant chemotherapy. The aim of this study was to assess the impact of cytoreductive surgery with or without the addition of HIPEC on renal function. Method This is a retrospective case-controlled study at a tertiary teaching hospital in Dublin, Ireland. All patients who had interval cytoreductive surgery (CRS) and HIPEC from October 2017 to October 2020 were included. A cohort of patients who had interval CRS without HIPEC were included as a control. Sodium thiosulphate (ST) was added to the HIPEC protocol in 2019. In order to assess the impact of ST as a renal protectant, renal function and post-operative outcomes were compared between the groups. Results Sixty patients who had interval CRS were included, thirty of whom received cisplatin-based HIPEC. Seven received cisplatin 50 mg/m2 without the addition of ST. Twenty three patients received cisplatin 100 mg/m2 and ST. There were no statistically differences in age, body mass index BMI, American society of anaesthesia score, estimated blood loss or peritoneal cancer index between the cohorts (p > 0.05). The only episode of acute kidney injury (AKI) was within the HIPEC cohort, after cisplatin 50 mg/m2 (without ST) and this was sustained at three months. In contrast, no patients within the CRS cohort or cisplatin 100 mg/m2 that received the addition of ST, sustained a renal injury and all had a creatinine within the normal range at three days post operatively. Conclusion The renal toxicity associated with cisplatin HIPEC and major abdominal surgery can be minimised with careful preoperative optimisation, intra operative fluid management and attention to renal function. The addition of sodium thiosulphate is a safe and effective method to minimise toxicity and should be added to any cisplatin HIPEC protocol.
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Coccolini F, Fugazzola P, Montori G, Ansaloni L, Chiarugi M. Intraperitoneal chemotherapy for ovarian cancer with peritoneal metastases, systematic review of the literature and focused personal experience. J Gastrointest Oncol 2021; 12:S144-S181. [PMID: 33968435 DOI: 10.21037/jgo-2020-06] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Epithelial ovarian cancer (EOC) causes 60% of ovarian cancer cases and is the fourth most common cause of death from cancer in women. The standard of care for EOC includes a combination of surgery followed by intravenous chemotherapy. Intraperitoneal (IP) chemotherapy (CT) has been introduced into the therapeutic algorithm of EOC with positive results. To explore existing results regarding intraperitoneal chemotherapy a systematic review of the literature and an analysis of our own institutional prospective database of patients treated with cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (HIPEC) for EOC at different stages were conducted. The focused report concerning our personal experience with advanced EOC treated with cytoreductive surgery and HIPEC produced the following results: In 57 patients cisplatin + paclitaxel as HIPEC was the only significant factor improving overall survival (OS) at multivariate analysis (OR 6.54, 95% CI: 1.24-34.47, P=0.027). Patients treated with HIPEC cisplatin + paclitaxel showed a median OS of 46 months (SD 6.4, 95% CI: 33.4-58.6), while patients treated with other HIPEC regimens showed a median OS of 12 months (SD 3.1, 95% CI: 6.0-18.0). The 2y-OS was 72% and 3y-OS was 68% for cisplatin + paclitaxel as HIPEC, while the 2y- and 3y-OS was 0% for other HIPEC regimens. Patients treated with HIPEC cisplatin + paclitaxel showed a median disease-free survival (DFS) of 13 months (SD 1.6, 95% CI: 9.9-16.1), while patients treated with other HIPEC regimens showed a median DFS of 8 months (SD 3.1, 95% CI: 1.9-14.1). In conclusion, HIPEC cisplatin + paclitaxel in ovarian cancer showed positive results that may be considered semi-definitive according to the level of evidence and should be considered a starting point for further investigations. At present HIPEC cisplatin + paclitaxel should be proposed to patients with advanced ovarian cancer as standard treatment at almost all stages of disease. Platinum + taxane-based intraperitoneal regimens demonstrated superior results compared to other regimens.
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Affiliation(s)
- Federico Coccolini
- General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Paola Fugazzola
- General, Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy
| | | | - Luca Ansaloni
- General, Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy
| | - Massimo Chiarugi
- General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
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Ha HI, Lim MC. How do we perform hyperthermic intraperitoneal chemotherapy in ovarian cancer? -a narrative review. Gland Surg 2021; 10:1235-1243. [PMID: 33842270 DOI: 10.21037/gs-20-425] [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: 11/06/2022]
Abstract
Ovarian malignancy is a leading cause of death caused by gynecologic cancer worldwide because it is mainly found in the advanced stage and recurs in most patients even after cytoreductive surgery and intravenous (IV) chemotherapy. Prevention of recurrence of primary disease and treatment of recurrent ovarian cancer are still remained as major interest and lots of researchers investigate novel treatment to find optimal method. Even though intraperitoneal (IP) chemotherapy turns out to increase the overall survival, it is not widely used because of adverse event. As an alternative treatment for IP chemotherapy, hyperthermic intraperitoneal chemotherapy (HIPEC) is emerging a new way. Thanks to much research and use in other cancer species, such as the colorectal cancer cytoreductive surgery followed by HIPEC is becoming a promising treatment. However, randomized controlled trials and unbiased data in ovarian cancer patients are still needed for the establishment of therapy. Moreover, among the current situation in which treatments such as bevacizumab or PARP inhibitor have been found to be effective and have been widely used, it may be necessary to establish the role in the combination of HIPEC. This article is a comprehensive review of the HIPEC in ovarian cancer to introduce techniques, treatment results, and clinical trials of HIPEC.
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Affiliation(s)
- Hyeong In Ha
- Department of Obstetrics and Gynecology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Myong Cheol Lim
- Research Institute and Hospital, National Cancer Center, Goyang, Korea
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Macrì A, Accarpio F, Arcoraci V, Casella F, De Cian F, De Iaco P, Orsenigo E, Roviello F, Scambia G, Saladino E, Galati M. Predictors of morbidity and mortality in patients submitted to cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy for ovarian carcinomatosis: a multicenter study. Pleura Peritoneum 2021; 6:21-30. [PMID: 34222647 PMCID: PMC8223801 DOI: 10.1515/pp-2020-0139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 11/02/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The aim of this retrospective study is to assess the incidence of morbidity and mortality related to cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) and to evaluate their predictors, in patients with peritoneal metastasis of ovarian origin. METHODS A retrospective multicenter study was carried out investigating results from eight Italian institutions. A total of 276 patients met inclusion criteria. Predictors of morbidity and mortality were evaluated with univariate and multivariate analysis. RESULTS Overall morbidity was 71.4%, and severe complications occurred in 23.9% of the sample; 60-day mortality was 4.3%. According to univariate logistic regression models, grade 3-4 morbidity was related to Peritoneal Cancer Index (PCI) (OR 1.06; 95% CI 1.02-1.09; p<0.001), number of intraoperative blood transfusions (OR 1.21; 95% CI 1.10-1.34; p<0.001), Completeness of Cytoreduction (CC) score (OR 1.68; 95% CI 1.16-2.44; p=0.006) and number of anastomoses (OR 1.32; 95% CI 1.00-1.73; p=0.046). However, at the multivariate logistic regression analysis, only the number of intraoperative blood transfusions (OR 1.17; 95% CI 1.5-1.30; p=0.004) and PCI (OR 1.04; 95% CI 1.01-1.08; p=0.010) resulted as key predictors of severe morbidity. Furthermore, using multivariate logistic regression model, ECOG score (OR 2.45; 95% CI 1.21-4.93; p=0.012) and the number of severe complications (OR 2.16; 95% CI 1.03-4.52; p=0.042) were recorded as predictors of exitus within 60 days. CONCLUSIONS The combination of CRS and HIPEC for treating peritoneal metastasis of ovarian origin has acceptable morbidity and mortality and, therefore, it can be considered as an option in selected patients.
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Affiliation(s)
- Antonio Macrì
- Department of Human Pathology, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | - Fabio Accarpio
- Cytoreductive Surgery and HIPEC Unit – Department of Surgery “Pietro Valdoni”, University “Sapienza” of Rome, Rome, Italy
| | - Vincenzo Arcoraci
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Francesco Casella
- 1st Department of General Surgery, University of Verona, Verona, Italy
| | - Franco De Cian
- Department of Surgery, University of Genoa, Genoa, Italy
| | - Pierandrea De Iaco
- Department of Obstetrics and Gynecology, St. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Elena Orsenigo
- Department of Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Franco Roviello
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Giovanni Scambia
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Marica Galati
- Emergency Surgery Unit, University Hospital, Messina, Italy
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19
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Zhang J, Mei L, Wang F, Li Y. Ten years' disease-free survival of advanced epithelial ovarian cancer treated by cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy: A case report and literature review. Medicine (Baltimore) 2020; 99:e23404. [PMID: 33285729 PMCID: PMC7717790 DOI: 10.1097/md.0000000000023404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE One of the most distinctive features of epithelial ovarian cancer is tendency to disseminate into peritoneal cavity to form peritoneal carcinomatosis, indicating advanced disease with poor prognosis. PATIENT CONCERNS A fifty-year-old patient had a chief complaint of an abdominal distension lasting 1 month. DIAGNOSES The patient was diagnosed with advanced epithelial ovarian cancer with peritoneal carcinomatosis by computed tomography scan, tumor markers, endoscopy examination, and pathology. INTERVENTIONS The patient was treated with cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy followed by 8 cycles of systemic chemotherapy. OUTCOMES Till March 9, 2020, the patient has disease-free survival over 10 years. LESSONS The application of cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy combined with systematic chemotherapy may improve survival dramatically for the patients with epithelial ovarian cancer and peritoneal carcinomatosis and should be considered as an option of a relatively new regime.
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Affiliation(s)
- Jue Zhang
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, PR. China
| | - Liejun Mei
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan 430071, PR. China
| | - Fubing Wang
- Department of Clinical Laboratory, Zhongnan Hospital of Wuhan University, Wuhan 430071, PR. China
| | - Yan Li
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, PR. China
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20
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The role of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the treatment of peritoneal carcinomatosis: a systematic review including evidence from Japan. Surg Today 2020; 51:1085-1098. [PMID: 33185798 DOI: 10.1007/s00595-020-02180-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/29/2020] [Indexed: 02/07/2023]
Abstract
The prognosis of peritoneal carcinomatosis is poor. However, the emergence of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) as a treatment option has prolonged survival and it can even potentially cure patients with peritoneal carcinomatosis. Randomized controlled studies and other observational studies indicated that this combined therapy potentially improved the prognosis of patients with colon, gastric, and ovarian cancers with acceptable morbidity and mortality rates. Even in rarer diseases, such as pseudomyxoma peritonei and malignant peritoneal mesothelioma, CRS + HIPEC markedly improved the prognoses over those with conventional treatment. Based on the accumulated evidence, clinical guidelines recommend CRS + HIPEC for selected patients with peritoneal carcinomatosis. However, several issues still need to be overcome. A standard method for HIPEC has not yet been established. Furthermore, the criteria employed for patient selection need to be clarified to achieve real benefits. The peritoneal cancer index, chemo-sensitivity and several biological markers are considered to be key factors.
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21
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Minareci Y, Tosun OA, Sozen H, Topuz S, Salihoglu MY. A Retrospective Clinical Analysis of Hyperthermic Intraperitoneal Chemotherapy in Gynecological Cancers: Technical Details, Tolerability, and Efficacy. Medeni Med J 2020; 35:202-211. [PMID: 33110672 PMCID: PMC7584260 DOI: 10.5222/mmj.2020.31855] [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: 07/05/2020] [Accepted: 08/26/2020] [Indexed: 11/30/2022] Open
Abstract
Objective The aim of this study was to reveal the results of hyperthermic intraperitoneal chemotherapy (HIPEC procedure) performed during cytoreductive surgery (CRS) in patients with endometrial cancer and epithelial ovarian cancer which included mainly platinum-resistant patients. Method Patients who underwent CRS+HIPEC between May 2015 and January 2020 were evaluated retrospectively. Surgical complications were graded according to the Clavien-Dindo classification. Results A total of 33 CRS+HIPEC procedures were performed in 32 patients, two of whom had recurrent endometrial cancer. Of the 30 patients with epithelial ovarian cancer (EOC), five underwent interval CRS+HIPEC, and remaining 25 patients underwent secondary CRS+HIPEC treatment due to relapsed disease. Eighteen of the patients with relapsed disease were platinum-resistant. The overall operative mortality and severe morbidity rates were %3 and 12%, respectively. For 30 patients with EOC, during a median follow-up period of 15 months, Kaplan-Meier survival analysis revealed a 1-year OS and PFS rates of 69.7% and 30.3%, respectively. Moreover, in the subgroup analysis of the platinum-resistant cohort, median OS and PFS were 14 and five months, respectively. Conclusion CRS+HIPEC procedures had acceptable severe morbidity and mortality rates. In addition, patients with recurrent EOC and without a visible residual disease at the end of cytoreductive surgery had, though not statistically significant, longer OS . HIPEC administration during CRS was not associated with adverse outcomes in the platinum-resistant EOC cohort. The short-term results of the current study are promising.
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Affiliation(s)
- Yagmur Minareci
- Istanbul University, Faculty of Medicine, Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, Istanbul, Turkey
| | - Ozgur Aydın Tosun
- Istanbul University, Faculty of Medicine, Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, İstanbul, Turkey
| | - Hamdullah Sozen
- Istanbul University, Faculty of Medicine, Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, Istanbul, Turkey
| | - Samet Topuz
- Istanbul University, Faculty of Medicine, Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, Istanbul, Turkey
| | - Mehmet Yavuz Salihoglu
- Istanbul University, Faculty of Medicine, Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, Istanbul, Turkey
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22
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Armstrong DK, Alvarez RD, Bakkum-Gamez JN, Barroilhet L, Behbakht K, Berchuck A, Berek JS, Chen LM, Cristea M, DeRosa M, ElNaggar AC, Gershenson DM, Gray HJ, Hakam A, Jain A, Johnston C, Leath CA, Liu J, Mahdi H, Matei D, McHale M, McLean K, O'Malley DM, Penson RT, Percac-Lima S, Ratner E, Remmenga SW, Sabbatini P, Werner TL, Zsiros E, Burns JL, Engh AM. NCCN Guidelines Insights: Ovarian Cancer, Version 1.2019. J Natl Compr Canc Netw 2020; 17:896-909. [PMID: 31390583 DOI: 10.6004/jnccn.2019.0039] [Citation(s) in RCA: 176] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Epithelial ovarian cancer is the leading cause of death from gynecologic cancer in the United States, with less than half of patients living >5 years from diagnosis. A major challenge in treating ovarian cancer is that most patients have advanced disease at initial diagnosis. The best outcomes are observed in patients whose primary treatment includes complete resection of all visible disease plus combination platinum-based chemotherapy. Research efforts are focused on primary neoadjuvant treatments that may improve resectability, as well as systemic therapies providing improved long-term survival. These NCCN Guidelines Insights focus on recent updates to neoadjuvant chemotherapy recommendations, including the addition of hyperthermic intraperitoneal chemotherapy, and the role of PARP inhibitors and bevacizumab as maintenance therapy options in select patients who have completed primary chemotherapy.
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Affiliation(s)
| | | | | | | | | | | | | | - Lee-May Chen
- UCSF Helen Diller Family Comprehensive Cancer Center
| | | | | | - Adam C ElNaggar
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | - Heidi J Gray
- University of Washington/Seattle Cancer Care Alliance
| | | | | | | | - Charles A Leath
- University of Alabama at Birmingham Comprehensive Cancer Center
| | - Joyce Liu
- Dana-Farber/Brigham and Women's Cancer Center
| | - Haider Mahdi
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Daniela Matei
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | - David M O'Malley
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
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23
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Effect of platinum sensitivity on the efficacy of hyperthermic intraperitoneal chemotherapy (HIPEC) in recurrent epithelial ovarian cancer. J Gynecol Obstet Hum Reprod 2020; 50:101844. [PMID: 32590110 DOI: 10.1016/j.jogoh.2020.101844] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 06/19/2020] [Accepted: 06/21/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Hyperthermic intraperitoneal chemotherapy following cytoreductive surgery (CRS) is a treatment strategy that has been evaluated in recurrent ovarian cancer. The aim of this study was to examine if survival was similar regardless of platinum sensitivity. METHODS A retrospective study of women with recurrent platinum sensitive or resisteant epithelial ovarian cancer who were treated with cytoreductive surgery (CRS) and HIPEC between the years 2010-2018 was performed. Recurrence free (RFS) and overall survival (OS) were calculated using the Kaplan-Meier method. RESULTS Thirty-five (72.9 %) were platinum sensitive (PS) and 13 (27.1 %) were platinum resistant (PR). The complete cytoreduction (R0) rate was higher in the PS patients as compared to PR (85.7 % vs 53.8 %; p = 0.017). Median follow-up was 16.9 (range, 11.7-34.5) months. The median recurrence free survival in the patients who had a R0 resection was 22.3 months in PS and 11.1 months in PR patients (p = 0.017), respectively. Median overall survival was 26.9 months in the PR patients, while it had not been reached in the PS patients. In the patients with PS recurrence, the mean treatment free interval (TFI) prior to HIPEC was 1.6 years and following HIPEC, 40 % of those patients were recurrence free at 2 years. In the patients with PR recurrence, the mean TFI prior to HIPEC was 4.6 months and following HIPEC, 61.5 % of those patients had a longer TFI, with a mean increase of 10.1 months. CONCLUSION Although surgery is not considered standard treatment in PR ovarian cancer, in carefully selected patients, surgery with HIPEC could extend the treatment-free interval.
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24
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Bouchard-Fortier G, Cusimano MC, Fazelzad R, Sajewycz K, Lu L, Espin-Garcia O, May T, Bouchard-Fortier A, Ferguson SE. Oncologic outcomes and morbidity following heated intraperitoneal chemotherapy at cytoreductive surgery for primary epithelial ovarian cancer: A systematic review and meta-analysis. Gynecol Oncol 2020; 158:218-228. [PMID: 32387131 DOI: 10.1016/j.ygyno.2020.03.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 03/31/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Heated intraperitoneal chemotherapy (HIPEC) has not been universally adopted at the time of interval cytoreductive surgery for primary epithelial ovarian cancer (EOC) despite evidence of a 12-month overall survival (OS) benefit in a recent landmark randomized trial. We performed a systematic review and meta-analysis to assess oncologic outcomes and perioperative morbidity following HIPEC among primary EOC patients. METHODS We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews, from inception to August 2019, for observational and randomized studies of primary EOC patients undergoing HIPEC. We assessed risk of bias using the Institute of Health Economics Quality Appraisal Checklist for single-arm cohort studies, Newcastle-Ottawa Scale for comparative cohort studies, and Cochrane Collaboration's Tool for randomized trials. We qualitatively summarized survival outcomes and calculated the pooled proportion of 30-day grade III-IV morbidity and postoperative death. RESULTS We identified 35 articles including 2252 primary EOC patients; one study was a randomized trial, and only six studies included a comparator group of surgery alone. The timing, temperature, and chemotherapeutic agents used for HIPEC differed across studies. Reported OS was highly variable (3-year OS range: 46-77%); three comparative cohort studies and the sole randomized trial reported statistically significant survival benefits for HIPEC over surgery alone, while two comparative cohort studies did not. The pooled proportions for grade III-IV morbidity and postoperative death at 30 days were 34% (95% CI 20-52) and 0% (95% CI 0-5) respectively. CONCLUSION One randomized trial suggests that HIPEC at time of interval cytoreductive surgery should be considered in patients with primary EOC. However, there is significant heterogeneity in literature with respect to an appropriate HIPEC regimen, short- and long-term outcomes. High-quality prospective randomized trials are urgently needed to clarify the role of HIPEC in the first-line treatment of primary EOC.
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Affiliation(s)
- Genevieve Bouchard-Fortier
- Department of Obstetrics & Gynecology, University of Toronto, Toronto, ON, Canada; Division of Gynecologic Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada.
| | - Maria C Cusimano
- Department of Obstetrics & Gynecology, University of Toronto, Toronto, ON, Canada
| | - Rouhi Fazelzad
- Princess Margaret Cancer Centre, University Health Network Library and Information Services, Toronto, ON, Canada
| | - Katrina Sajewycz
- Division of Gynecologic Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Lin Lu
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Osvaldo Espin-Garcia
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Taymaa May
- Department of Obstetrics & Gynecology, University of Toronto, Toronto, ON, Canada; Division of Gynecologic Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Sarah E Ferguson
- Department of Obstetrics & Gynecology, University of Toronto, Toronto, ON, Canada; Division of Gynecologic Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
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25
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Li XB, Peng KW, Ji ZH, Yu Y, Liu G, Li Y. Prevention of Venous Thromboembolism After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Development of a Physiotherapy Program. Clin Appl Thromb Hemost 2020; 25:1076029619890415. [PMID: 31775523 PMCID: PMC7019383 DOI: 10.1177/1076029619890415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: This study was to assess the risk of venous thromboembolism (VTE) in patients with
peritoneal carcinomatosis (PC) and to evaluate the safety and feasibility of
physiotherapy program to prevent VTE during cytoreductive surgery (CRS) and hyperthermic
intraperitoneal chemotherapy (HIPEC). Methods: For VTE prevention, we developed a systematic physiotherapy program consisting of
active exercises of both arms and legs, and intermittent pneumatic compression device to
massage both legs. This physiotherapy was applied to all patients, and the VTE-related
events were recorded and analyzed. Results: Cytoreductive surgery + HIPEC was performed on 466 patients with PC. All patients had
highest VTE risk, with the median Caprini risk factor score being 11. During the 3-month
observation period, 8 patients had 9 (1.9%) clinically symptomatic VTE events, including
8 (1.7%) deep vein thrombosis and 1 (0.2%) pulmonary embolism. Among those, 5 patients
received pharmacological treatments with low-molecular-weight heparin, and the other 3
received physical exercises only. All these patients recovered well, and there was no
mortality about VTE perioperatively. Conclusions: Patients with PC treated by CRS + HIPEC are at highest risk for VTE. The systematic
physiotherapy program is safe and feasible to prevent VTE post CRS + HIPEC.
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Affiliation(s)
- Xin-Bao Li
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Kai-Wen Peng
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Zhong-He Ji
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Yang Yu
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Gang Liu
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Yan Li
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
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26
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Ha M, Kim J, Park SM, Hong CM, Han ME, Song P, Kang CD, Lee D, Kim YH, Hur J, Oh SO. Prognostic Role of Zinc Finger Homeobox 4 in Ovarian Serous Cystadenocarcinoma. Genet Test Mol Biomarkers 2020; 24:145-149. [PMID: 32105524 DOI: 10.1089/gtmb.2019.0185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Introduction: The zinc finger homeobox 4 (ZFHX4) protein is a crucial molecular regulator of tumor-initiating stem cell-like functions. Objective: This study aimed to determine the role of ZFHX4 in the progression of ovarian serous cystadenocarcinoma (OSC). Methods: Differential gene expression ZFHX4 among low-stage (stages I and II), high-stage (stages III and IV), low-grade (grades I and II), and high-grade (grades III and IV) OSC patients was identified using four independent cohorts from the Cancer Genome Atlas (TCGA) and the Gene Expression Omnibus (GEO). We compared ZFHX4 expression as a prognostic factor using Kaplan-Meier survival curves, multivariate analysis, the time-dependent area under the curve (AUC) of Uno's C-index, and the AUC of the receiver operating characteristics at 4 years post diagnosis. Results: ZFHX4 gene expression in high-stage tumors is significantly higher than in low-stage tumors (TCGA, p = 0.007; GSE9891, p = 0.001). A Kaplan-Meier analysis revealed that elevated expression of ZFHX4 was associated with a poor prognosis in OSC patients for all cohorts, regardless of stage and grade (TCGA, p = 1e-04; GSE9891, p = 0.0044; GSE13876, p = 0.00078; GSE26712, p = 0.039). Analysis of C-indices and the area under the receiver operating characteristic curve further supported this result (C-index: TCGA, 0.599; GSE9891, 0.642; GSE13876, 0.585; GSE26712, 0.597). Moreover, univariate and multivariate Cox hazards analyses confirmed the prognostic significance of ZFHX4 levels. Conclusion: Collectively, these findings suggest that ZFHX4 is a prognostic factor for OSC.
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Affiliation(s)
- Mihyang Ha
- Department of Anatomy, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Jayoung Kim
- Department of Convergence Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Su Min Park
- Department of Convergence Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Chae Mi Hong
- Department of Convergence Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Myoung-Eun Han
- Department of Anatomy, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Parkyong Song
- Department of Convergence Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Chi-Dug Kang
- Department of Convergence Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea.,Department of Biochemistry, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Dongjun Lee
- Department of Convergence Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Yun Hak Kim
- Department of Anatomy, Biomedical Research Institute, Pusan National University School of Medicine, Yangsan, Republic of Korea.,Department of Biomedical Informatics, Biomedical Research Institute, Pusan National University School of Medicine, Yangsan, Republic of Korea.,Biomedical Research Institute, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Jin Hur
- Department of Convergence Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Sae-Ock Oh
- Department of Anatomy, Pusan National University School of Medicine, Yangsan, Republic of Korea
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27
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Zhang PF, Wu J, Luo JH, Li KS, Wang F, Huang W, Wu Y, Gao SP, Zhang XM, Zhang PN. SNHG22 overexpression indicates poor prognosis and induces chemotherapy resistance via the miR-2467/Gal-1 signaling pathway in epithelial ovarian carcinoma. Aging (Albany NY) 2019; 11:8204-8216. [PMID: 31581131 PMCID: PMC6814594 DOI: 10.18632/aging.102313] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 09/21/2019] [Indexed: 12/13/2022]
Abstract
Recently, an increasing number of studies have reported that dysregulation of long noncoding RNAs (lncRNAs) plays an important role in cancer initiation and progression, including in epithelial ovarian carcinoma (EOC). However, little is known about the detailed biological functions of the lncRNA small nucleolar RNA host gene 22 (SNHG22) during the progression of EOC. Here, we found that SNHG22 was significantly increased in EOC tissues and was significantly associated with a low level of differentiation. Forced SNHG22 expression promoted chemotherapy resistance in EOC cells. Knockdown of SNHG22 expression increased the sensitivity of EOC cells to cisplatin and paclitaxel. Importantly, we found that SNHG22 could directly interact with miR-2467 and lead to the release of miR-2467-targeted Gal-1 mRNA. Moreover, SNHG22 overexpression induced EOC cell resistance to chemotherapy agents via PI3K/AKT and ERK cascade activation. In summary, our findings demonstrate that SNHG22 plays a critical role in the chemotherapy resistance of EOC by mediating the miR-2467/Gal-1 regulatory axis.
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Affiliation(s)
- Peng-Fei Zhang
- Department of Oncology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jing Wu
- Department of Oncology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jin-Hong Luo
- Department of Oncology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ke-Sang Li
- Department of Hematology and Oncology, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Fei Wang
- Department of Oncology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wei Huang
- Department of Oncology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yin Wu
- Department of Oncology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shui-Ping Gao
- Department of Oncology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xue-Mei Zhang
- Department of Oncology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Peng-Nan Zhang
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, China
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28
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Ba M, Long H, Zhang X, Yan Z, Wang S, Wu Y, Gong Y, Cui S. Ascites do not affect the rate of complete cytoreductive surgery and prognosis in patients with primary ovarian cancer with ascites treated with hyperthermic intraperitoneal chemotherapy. Oncol Lett 2019; 18:2025-2033. [PMID: 31423274 DOI: 10.3892/ol.2019.10493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 08/06/2018] [Indexed: 12/29/2022] Open
Abstract
Cytoreductive surgery (CRS) is the current standard therapy procedure for patients with advanced ovarian cancer (OC), but numerous patients with OC are complicated with ascites. The aim of the present study was to assess whether massive ascites affect the rate of complete CRS and prognosis for patients with primary OC treated with hyperthermic intraperitoneal chemotherapy (HIPEC). Between December 2006 and December 2015, 1,293 patients with primary OC from the Intracelom Hyperthermic Perfusion Therapy Center of the Cancer Hospital of Guangzhou Medical University prospective database were treated with CRS combined with HIPEC. A total of 1,225 patients were without malignant ascites or small amounts of ascites and 68 had massive malignant ascites. The rate of complete CRS, overall survival (OS), disease-free survival (DFS) and resolution of ascites for patients with massive ascites were analyzed between patients without/small ascites, and with massive ascites. Complete CRS was successful in 86.8% (1,063/1,225) of patients without/small ascites, and 85.3% (58/68) of patients with massive ascites. No statistical differences were identified in complete CRS success between patients with ascites and patients without/small ascites (P=0.080). For patients with massive ascites, all symptoms exhibited regression; the total objective remission rate was 100% (68/68), even for patients with incomplete CRS (10/68) (P=0.100). The mean OS was 58 months and the mean DFS was 26 months in patients without/small ascite, vs. 57 months and 28 months in patients with massive ascites. No significant differences were noted in median DFS and median OS between patients with ascites, and patients without/small ascites (All P>0.05). In conclusion, the results of the present study suggest that ascites does not affect the rate of complete CRS and the prognosis of patients with massive ascites following HIPEC. CRS is suitable for the majority of patients with primary OC and massive ascites.
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Affiliation(s)
- Mingchen Ba
- Intracelom Hyperthermic Perfusion Therapy Center, Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, Guangdong 510095, P.R. China
| | - Hui Long
- Guangzhou Dermatology Institute, Guangzhou, Guangdong 510095, P.R. China
| | - Xiangliang Zhang
- Intracelom Hyperthermic Perfusion Therapy Center, Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, Guangdong 510095, P.R. China
| | - Zhaofei Yan
- Intracelom Hyperthermic Perfusion Therapy Center, Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, Guangdong 510095, P.R. China
| | - Shuai Wang
- Intracelom Hyperthermic Perfusion Therapy Center, Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, Guangdong 510095, P.R. China
| | - Yinbing Wu
- Intracelom Hyperthermic Perfusion Therapy Center, Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, Guangdong 510095, P.R. China
| | - Yuanfeng Gong
- Intracelom Hyperthermic Perfusion Therapy Center, Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, Guangdong 510095, P.R. China
| | - Shuzhong Cui
- Guangzhou Baorui Medical Technology Co., Ltd. Guangzhou, Guangdong 510540, P.R. China
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29
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Farrell R. Is peritonectomy and hyperthermic intraperitoneal chemotherapy a new standard of treatment for advanced epithelial ovarian cancer? Aust N Z J Obstet Gynaecol 2019; 59:335-340. [DOI: 10.1111/ajo.12953] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 12/28/2018] [Indexed: 01/26/2023]
Affiliation(s)
- Rhonda Farrell
- Prince of Wales Private Hospital Sydney New South Wales Australia
- Department of SurgerySt George HospitalUNSW Sydney New South Wales Australia
- Chris O’Brien LifehouseCamperdown Sydney New South Wales Australia
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Fugazzola P, Ansaloni L, Sartelli M, Catena F, Cicuttin E, Leandro G, De' Angelis GL, Gaiani F, Di Mario F, Tomasoni M, Coccolini F. Advanced gastric cancer: the value of surgery. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:110-116. [PMID: 30561428 PMCID: PMC6502221 DOI: 10.23750/abm.v89i8-s.7897] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Indexed: 02/06/2023]
Abstract
Gastric cancer is a common disease with high mortality. The definition of advanced gastric cancer is still debated. Radical surgery associated to appropriate systemic and intra-abdominal chemotherapy is the gold standard treatment. In presence of peritoneal carcinosis, reaching a complete cytoreduction is the key to achieve long-term survival. Adequate lymphadenectomy is also fundamental. Conversion therapy could be applied to selected IV stage patients. No definitive evidences exist regarding the oncological and surgical superiority of mini-invasive approaches over the classical open techniques.
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Affiliation(s)
- Paola Fugazzola
- Emergency, General and Trauma Surgery dept., Bufalini hospital, Cesena, Italy.
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Zivanovic O, Chi DS, Filippova O, Randall LM, Bristow RE, O'Cearbhaill RE. It's time to warm up to hyperthermic intraperitoneal chemotherapy for patients with ovarian cancer. Gynecol Oncol 2018; 151:555-561. [PMID: 30249527 PMCID: PMC6684262 DOI: 10.1016/j.ygyno.2018.09.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/01/2018] [Accepted: 09/06/2018] [Indexed: 01/05/2023]
Abstract
The peritoneal spread of ovarian cancer makes it a potential target for hyperthermic intraperitoneal chemotherapy (HIPEC). Intraperitoneal delivery exposes the tumor to concentrations of cytotoxic drugs much greater than with intravenous delivery, and in vitro studies have also shown that combining hyperthermia and platinum leads to an additive cytotoxic effect. Pharmacokinetic analyses have confirmed very high concentrations of cytotoxic drugs in the peritoneal cavity, with minimal systemic exposure and toxicity. The majority of historical data evaluating HIPEC in ovarian cancer are based on retrospective research, which included heterogeneous groups of patients and drugs used for HIPEC. Recent publications on the findings of prospective studies, including the first randomized trial in which the only difference in intervention was the addition of HIPEC with cisplatin to interval debulking surgery in stage III patients, have shown a benefit in favor of HIPEC. Yet, a recent prospective study from Korea did not find a benefit. Opponents of HIPEC have cited higher rates of complications with this approach, yet most of the serious adverse events observed are likely related to the surgery itself, and are comparable to the rates reported in studies evaluating cytoreductive surgery without HIPEC. Findings from a recent randomized controlled trial showed no delays in initiation or completion of postoperative chemotherapy in patients treated with HIPEC. A growing body of evidence is indicating that it might be time to seriously consider HIPEC as a complementary treatment at the time of cytoreductive surgery for patients with advanced-stage ovarian cancer in the setting of an experienced center. Yet, more research is needed to identify the population of patients who gain the most benefit from this therapy.
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Affiliation(s)
- Oliver Zivanovic
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA.
| | - Dennis S Chi
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Olga Filippova
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Leslie M Randall
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Irvine Medical Center, University of California, Orange, CA, USA
| | - Robert E Bristow
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Irvine Medical Center, University of California, Orange, CA, USA
| | - Roisin E O'Cearbhaill
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA
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Guo W, Zhu L, Yu M, Zhu R, Chen Q, Wang Q. A five-DNA methylation signature act as a novel prognostic biomarker in patients with ovarian serous cystadenocarcinoma. Clin Epigenetics 2018; 10:142. [PMID: 30446011 PMCID: PMC6240326 DOI: 10.1186/s13148-018-0574-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 10/28/2018] [Indexed: 12/25/2022] Open
Abstract
Background Ovarian cancer is the most fatal tumor of the female reproductive system and the fifth leading cause of cancer death among women in the USA. The prognosis is poor due to the lack of biomarkers for treatment options. Results The methylation array data of 551 patients with ovarian serous cystadenocarcinoma (OSC) in The Cancer Genome Atlas (TCGA) database were assessed in this study to explore the methylation biomarkers associated with prognosis and improve the prognosis of patients. These patients were divided into training (first two thirds) and validation datasets (remaining one third). A five-DNA methylation signature was found to be significantly associated with the overall survival of patients with OSC using the Cox regression analysis in the training dataset. The Kaplan–Meier analysis showed that the five-DNA methylation signature could significantly distinguish the high- and low-risk patients in both training and validation sets. The receiver operating characteristic (ROC) analysis further confirmed that the five-DNA methylation signature exhibited high sensitivity and specificity to predict the prognostic survival of patients. Also, the five-DNA methylation signature was not only applicable in patients of different ages, stages, histologic grade, and size of residual tumor after surgery but also more accurate in predicting OSC prognosis compared with known biomarkers. Conclusions This five-DNA methylation signature demonstrated the potential of being a novel independent prognostic indicator and served as an important tool for guiding the clinical treatment of OSC to improve outcome prediction and management for patients. Hence, the findings of this study might have potential clinical significance. Electronic supplementary material The online version of this article (10.1186/s13148-018-0574-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wenna Guo
- State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, China
| | - Liucun Zhu
- School of Life Sciences, Shanghai University, Shanghai, China
| | - Minghao Yu
- State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, China
| | - Rui Zhu
- School of Life Sciences, Shanghai University, Shanghai, China
| | - Qihan Chen
- State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, China.
| | - Qiang Wang
- State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, China.
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Lee YJ, Lee JY, Cho MS, Nam EJ, Kim SW, Kim S, Kim YT. Incorporation of paclitaxel-based hyperthermic intraperitoneal chemotherapy in patients with advanced-stage ovarian cancer treated with neoadjuvant chemotherapy followed by interval debulking surgery: a protocol-based pilot study. J Gynecol Oncol 2018; 30:e3. [PMID: 30479087 PMCID: PMC6304402 DOI: 10.3802/jgo.2019.30.e3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 08/17/2018] [Accepted: 08/31/2018] [Indexed: 02/07/2023] Open
Abstract
Objectives We conducted a protocol-based cohort study to evaluate the outcomes of interval debulking surgery (IDS) followed by paclitaxel-based hyperthermic intraperitoneal chemotherapy (HIPEC) for the treatment of advanced-stage ovarian cancer. Methods From October 2015 to May 2018, 65 patients with stages IIIC–IV ovarian cancer were treated according to the study protocol. HIPEC was performed with paclitaxel (175 mg/m2) for 90 minutes, only in cases of optimal cytoreduction. Results Of 65 patients, 40 (61.5%) patients underwent neoadjuvant chemotherapy (NAC), 34 (52.3%) patients had a high tumor burden with a Fagotti score ≥8 at diagnostic laparoscopy, and 6 (9.2%) had definite stage IV metastasis and/or poor performance status before NAC. Twenty-seven (41.5%) patients underwent IDS followed by HIPEC. The mean duration of IDS with HIPEC was 543.8 (range, 277.0–915.0) minutes. Grade III/IV perioperative complications occurred in 7.4% (n=2)/3.7% (n=1) of patients and no cases of mortality were reported within 30 days postoperatively. The median progression-free survival was 21.3 months, and the median overall survival was not reached for those who received HIPEC. Conclusions According to our study protocol, IDS followed by paclitaxel-based HIPEC as a first-line treatment appears to be feasible and safe for the treatment of advanced-stage ovarian cancer. Further evaluations of this procedure are required to assess its survival benefits.
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Affiliation(s)
- Yong Jae Lee
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Yun Lee
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea.
| | - Min Soo Cho
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Ji Nam
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Wun Kim
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Sunghoon Kim
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Young Tae Kim
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
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Hyperthermic Intraperitoneal Chemotherapy (HIPEC) as Primary Treatment of Ovarian Cancer: A Review of the Current Literature. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2018. [DOI: 10.1007/s40944-018-0218-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Horvath P, Königsrainer A. [Surgical treatment of peritoneal metastases from gynecological primary tumors]. Chirurg 2018; 89:678-686. [PMID: 29974140 DOI: 10.1007/s00104-018-0679-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The principle of surgical treatment of peritoneal metastases of ovarian cancer in the primary as well as in the recurrent disease setting includes macroscopic complete cytoreductive surgery. The addition of intraperitoneal chemotherapy after cytoreduction is currently not part of the standard treatment. OBJECTIVE Data on intraperitoneal chemotherapy for treatment of peritoneal metastases of ovarian cancer are presented focusing on overall and progression-free survival and on morbidity and mortality rates. METHOD PubMed search including the following terms: ovarian cancer, peritoneal metastases, cytoreduction and HIPEC. RESULTS Randomized-controlled and non-randomized controlled trials showed that intraperitoneal chemotherapy after maximum cytoreductive surgery results in a survival benefit regarding overall and progression-free survival for primary as well as recurrent disease. Addition of HIPEC does not impact on the initiation of postoperative systemic chemotherapy. CONCLUSION Macroscopic complete cytoreduction is the most important prognostic factor. The addition of intraperitoneal chemotherapy for the treatment of peritoneal metastases of ovarian cancer showed promising results but so far it is not accepted as a part of a multimodal treatment concept.
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Affiliation(s)
- P Horvath
- Abteilung für Allgemeine, Viszeral- und Transplantationschirurgie, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Deutschland
| | - A Königsrainer
- Abteilung für Allgemeine, Viszeral- und Transplantationschirurgie, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Deutschland.
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Wu T, Zhao XX, Wang GQ. Hyperthermic intraperitoneal chemotherapy in advanced ovarian cancer. J Gynecol Oncol 2018; 29:e51. [PMID: 29770622 PMCID: PMC5981103 DOI: 10.3802/jgo.2018.29.e51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 03/03/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
- Tao Wu
- Department of Gynecologic Cancer, Shaanxi Provincial Tumor Hospital, Xian, China
| | - Xi Xia Zhao
- Department of Gynecologic Cancer, Shaanxi Provincial Tumor Hospital, Xian, China
| | - Guo Qing Wang
- Department of Gynecologic Cancer, Shaanxi Provincial Tumor Hospital, Xian, China.
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Kireeva GS, Gafton GI, Guseynov KD, Senchik KY, Belyaeva OA, Bespalov VG, Panchenko AV, Maydin MA, Belyaev AM. HIPEC in patients with primary advanced ovarian cancer: Is there a role? A systematic review of short- and long-term outcomes. Surg Oncol 2018; 27:251-258. [PMID: 29937179 DOI: 10.1016/j.suronc.2018.05.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 02/13/2018] [Accepted: 05/02/2018] [Indexed: 12/12/2022]
Abstract
A systematic review of the studies where HIPEC combined with cytoreductive surgery was used in patients with primary advanced ovarian cancer was performed to understand is there a role for this treatment modality not only in recurrent but in primary advanced ovarian cancer. The results are controversial but there is a strong trend for improvement of the long-term outcomes of patients with primary advanced ovarian cancer after HIPEC.
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Affiliation(s)
- G S Kireeva
- N.N. Petrov National Medical Research Center of Oncology of the Russian Ministry of Health, 68, Leningradskaya Str., Pesochny, Saint-Petersburg, Russia, 197758.
| | - G I Gafton
- N.N. Petrov National Medical Research Center of Oncology of the Russian Ministry of Health, 68, Leningradskaya Str., Pesochny, Saint-Petersburg, Russia, 197758
| | - K D Guseynov
- N.N. Petrov National Medical Research Center of Oncology of the Russian Ministry of Health, 68, Leningradskaya Str., Pesochny, Saint-Petersburg, Russia, 197758
| | - K Y Senchik
- N.N. Petrov National Medical Research Center of Oncology of the Russian Ministry of Health, 68, Leningradskaya Str., Pesochny, Saint-Petersburg, Russia, 197758
| | - O A Belyaeva
- N.N. Petrov National Medical Research Center of Oncology of the Russian Ministry of Health, 68, Leningradskaya Str., Pesochny, Saint-Petersburg, Russia, 197758
| | - V G Bespalov
- N.N. Petrov National Medical Research Center of Oncology of the Russian Ministry of Health, 68, Leningradskaya Str., Pesochny, Saint-Petersburg, Russia, 197758
| | - A V Panchenko
- N.N. Petrov National Medical Research Center of Oncology of the Russian Ministry of Health, 68, Leningradskaya Str., Pesochny, Saint-Petersburg, Russia, 197758
| | - M A Maydin
- N.N. Petrov National Medical Research Center of Oncology of the Russian Ministry of Health, 68, Leningradskaya Str., Pesochny, Saint-Petersburg, Russia, 197758
| | - A M Belyaev
- N.N. Petrov National Medical Research Center of Oncology of the Russian Ministry of Health, 68, Leningradskaya Str., Pesochny, Saint-Petersburg, Russia, 197758
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Ji ZH, Peng KW, Yu Y, Li XB, Yonemura Y, Liu Y, Sugarbaker PH, Li Y. Current status and future prospects of clinical trials on CRS + HIPEC for gastric cancer peritoneal metastases. Int J Hyperthermia 2018; 33:562-570. [PMID: 28124576 DOI: 10.1080/02656736.2017.1283065] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE There is no standard treatment for peritoneal metastases (PM) from gastric cancer (GC). The aim of this review is to evaluate the clinical trials on cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) for GC PM. MATERIALS AND METHODS The published clinical trials on CRS + HIPEC for GC PM are critically evaluated, and survival and safety are the primary endpoints. In addition, the registered ongoing clinical trials are summarised. RESULTS The natural course of GC PM is <5 months. CRS + HIPEC could improve the overall survival (OS). In prospective studies, the median OS was 11.0 months in the CRS + HIPEC group vs. 5.4 months in the CRS alone group. In case-control studies, the median OS was 13.3 months in the CRS + HIPEC group vs. 7.9 months in the CRS alone group. In cohort studies, the median OS after CRS + HIPEC was 13.3. The median 1-, 2- and 5-year survival rates after CRS + HIPEC were 50.0%, 35.8% and 13.0%, respectively. There is no statistically significant increase in serious adverse events that are directly attributed to CRS + HIPEC. CONCLUSIONS The combination of CRS and HIPEC is a promising integrated treatment strategy for GC PM that has encouraging initial results, calling for urgent further evaluation of this strategy in randomised control trials (RCTs).
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Affiliation(s)
- Zhong-He Ji
- a Department of Peritoneal Cancer Surgery , Beijing Shijitan Hospital, Capital Medical University , Beijing , China
| | - Kai-Wen Peng
- b Department of Oncology , Zhongnan Hospital of Wuhan University, Hubei Key Laboratory of Tumor Biological Behaviors and Hubei Cancer Clinical Study Center , Wuhan , China
| | - Yang Yu
- a Department of Peritoneal Cancer Surgery , Beijing Shijitan Hospital, Capital Medical University , Beijing , China
| | - Xin-Bao Li
- a Department of Peritoneal Cancer Surgery , Beijing Shijitan Hospital, Capital Medical University , Beijing , China
| | - Yutaka Yonemura
- c NPO Organization to Support Peritoneal Dissemination Treatment , Kishiwada, Osaka , Japan
| | - Yang Liu
- c NPO Organization to Support Peritoneal Dissemination Treatment , Kishiwada, Osaka , Japan
| | | | - Yan Li
- a Department of Peritoneal Cancer Surgery , Beijing Shijitan Hospital, Capital Medical University , Beijing , China.,b Department of Oncology , Zhongnan Hospital of Wuhan University, Hubei Key Laboratory of Tumor Biological Behaviors and Hubei Cancer Clinical Study Center , Wuhan , China
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Ceresoli M, Verrengia A, Montori G, Busci L, Coccolini F, Ansaloni L, Frigerio L. Effect of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy on relapse pattern in primary epithelial ovarian cancer: a propensity score based case-control study. J Gynecol Oncol 2018. [PMID: 29533028 PMCID: PMC5920229 DOI: 10.3802/jgo.2018.29.e53] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Hyperthermic intraperitoneal chemotherapy (HIPEC) has been proposed as a treatment in ovarian cancer. A recently published RCT demonstrated that HIPEC prolongs disease-free survival (DFS) and overall survival (OS) in ovarian cancer. The aim of the study was to investigate oncologic results of cytoreductive surgery+HIPEC compared with cytoreductive surgery alone in advanced primary ovarian cancer with a particular attention to the pattern of recurrence. METHODS This is a retrospective case control study with a propensity score (PS) matching of the patients. All the patients treated for primary advanced ovarian cancer who underwent interval surgery with or without HIPEC were collected; a PS was calculated in order to match cases to controls. RESULTS Among 77 eligible patients 56 patients were included in the study. Preoperative patients' characteristics were homogeneous. No difference in morbidity and mortality after surgery were recorded. DFS was not different among the 2 groups (13.2 vs. 13.9 months, p=0.454) but OS was better in patients treated with HIPEC with no median reached vs. 35.5 months (p=0.048). Patients treated with cytoreductive surgery alone were more likely to have a peritoneal recurrence (43% vs. 14%). CONCLUSION HIPEC seems to affect the relapse pattern with lesser peritoneal recurrence. This difference in relapse pattern seems to affect the OS with better results in patients treated with HIPEC. Further studies are needed to confirm these findings.
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Affiliation(s)
- Marco Ceresoli
- Unit of General and Emergency Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
| | | | - Giulia Montori
- Unit of General and Emergency Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Luisa Busci
- Unit of Gynecology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Federico Coccolini
- Unit of General and Emergency Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Luca Ansaloni
- Unit of General and Emergency Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Luigi Frigerio
- Unit of Gynecology, Papa Giovanni XXIII Hospital, Bergamo, Italy
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Hyperthermic Intraperitoneal Perfusion Chemotherapy and Cytoreductive Surgery for Controlling Malignant Ascites From Ovarian Cancer. Int J Gynecol Cancer 2018; 26:1571-1579. [PMID: 27779544 DOI: 10.1097/igc.0000000000000809] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Malignant ascites, a complication often seen in patients with ovarian cancer (OC), is difficult to treat, but hyperthermic intraperitoneal chemotherapy (HIPEC) has a good efficacy. OBJECTIVE The aim of this study was to assess the efficacy of cytoreductive surgery (CRS) combined with HIPEC for controlling malignant ascites from OC. MATERIALS AND METHODS From December 2009 until December 2014, 53 patients with OC and malignant ascites were treated with CRS and HIPEC. Patients in good health condition were treated with CRS followed by HIPEC (CRS + HIPEC), and patients in poor health condition were treated initially with B-mode ultrasound-guided HIPEC followed by delayed CRS upon improvement of their health condition (HIPEC + delayed CRS). Resolution of ascites, complete CRS, overall survival, and disease-free survival were analyzed. RESULTS All patients showed ascites regression. The total objective remission rate was 100%, even for patients in the poor condition group before CRS. Complete CRS was successful in 30 (88.23%) of 34 patients in the good condition group, and 17 (89.47%) of 19 patients in the poor condition group (P > 0.05). Median disease-free survival and median overall survival were 21 and 39 months in the good condition group, and 22 and 38 months in the poor condition group, respectively (P > 0.05). CONCLUSIONS Hyperthermic intraperitoneal chemotherapy is effective at controlling ascites in patients with OC, even for patients in poor condition before CRS, or when complete CRS is not feasible. Furthermore, the regression of ascites appears not to be dependent on complete resection.
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Pavlov MJ, Ceranic MS, Latincic SM, Sabljak PV, Kecmanovic DM, Sugarbaker PH. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for the treatment of advanced epithelial and recurrent ovarian carcinoma: a single center experience. Int J Hyperthermia 2017; 34:564-569. [PMID: 28877609 DOI: 10.1080/02656736.2017.1371341] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND With standard treatment of epithelial ovarian cancer (EOC), prognosis is very poor. The aim of this study is to show early and late results in patients who underwent cytoreductive surgery and intraperitoneal chemotherapy. PATIENTS AND METHODS This was a retrospective single centre study. All patients with advanced and recurrent ovarian cancer treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) or modified early postoperative intraperitoneal chemotherapy (EPIC) were included in the study. RESULTS In the period 1995-2014, 116 patients were treated, 55 with primary EOC and 61 with recurrent EOC. The mean age was 59 years (26-74). Statistically, median survival time was significantly longer in the group with primary advanced cancer of the ovary (41.3 months) compared to relapsed ovarian cancer (27.3 months). Survival for the primary EOC was 65 and 24% at 3 and 5 years, respectively. Survival for recurrent EOC was 33 and 16% at 3 and 5 years, respectively. Mortality was 1/116 (0.8%). Morbidity was 11/116 (9.5%). Peritoneal cancer index (PCI) was ≤20 in 59 (51%) patients and statistically, their average survival was significantly longer than in the group of 57 (49%) patients with PCI >20 (p = 0.014). CONCLUSIONS In advanced or recurrent EOC, a curative therapeutic approach was pursued that combined optimal cytoreductive surgery and intraperitoneal chemotherapy. PCI and timing of the intervention (primary or recurrent) were the strongest independent prognostic factors.
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Affiliation(s)
- Maja J Pavlov
- a School of Medicine , University of Belgrade , Belgrade , Serbia.,b Department for Colorectal and Pelvic Surgery , First Surgical Clinic, Clinical Center of Serbia , Belgrade , Serbia
| | - Miljan S Ceranic
- a School of Medicine , University of Belgrade , Belgrade , Serbia.,b Department for Colorectal and Pelvic Surgery , First Surgical Clinic, Clinical Center of Serbia , Belgrade , Serbia
| | - Stojan M Latincic
- b Department for Colorectal and Pelvic Surgery , First Surgical Clinic, Clinical Center of Serbia , Belgrade , Serbia
| | - Predrag V Sabljak
- a School of Medicine , University of Belgrade , Belgrade , Serbia.,c Department for Esophagogastric Surgery , First Surgical Clinic, Clinical Center of Serbia , Belgrade , Serbia
| | - Dragutin M Kecmanovic
- a School of Medicine , University of Belgrade , Belgrade , Serbia.,b Department for Colorectal and Pelvic Surgery , First Surgical Clinic, Clinical Center of Serbia , Belgrade , Serbia
| | - Paul H Sugarbaker
- d Center for Gastrointestinal Malignancies, MedStar Washington Cancer Institute, MedStar Washington Hospital Center , Washington , DC , USA
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42
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Magge D, Ramalingam L, Shuai Y, Edwards RP, Pingpank JF, Ahrendt SS, Holtzman MP, Zeh HJ, Bartlett DL, Choudry HA. Hyperthermic intraperitoneal chemoperfusion as a component of multimodality therapy for ovarian and primary peritoneal cancer. J Surg Oncol 2017. [PMID: 28628712 DOI: 10.1002/jso.24666] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVES The role of hyperthermic intraperitoneal chemoperfusion (HIPEC) in the multimodality treatment of ovarian peritoneal metastases (OPM) and primary peritoneal cancer (PPC) remains controversial. We hypothesized that cytoreductive surgery (CRS) and HIPEC would provide meaningful survival benefit without excessive morbidity. METHODS We reviewed clinicopathologic and perioperative data following 96 CRS-HIPEC procedures for primary or recurrent OPM and PPC. Kaplan-Meier survival curves and multivariate Cox-regression models identified prognostic factors affecting oncologic outcomes. RESULTS CRS-HIPEC was mostly performed for recurrent disease (56.3%) and high-grade serous carcinoma (72.9%). Platinum-based systemic chemotherapy was administered to 89.5% of patients, with 75.5% having platinum-sensitive disease at CRS-HIPEC. Complete macroscopic resection was achieved in 70.8% of patients. Clavien-Dindo grade 3/4 morbidity occurred in 23.4% of patients; three patients died within 60-days postoperatively. Median overall survival from diagnosis of peritoneal metastases and CRS-HIPEC was 78 and 38 months, respectively. Completeness of cytoreduction, pathologic subtype, and 30-day morbidity were independent predictors of survival in multiple regression analysis. CONCLUSIONS Our study demonstrates promising survival data and supports the role of HIPEC in the multimodality treatment algorithm for primary or recurrent OPM and PPC. However definite indications and timing of HIPEC need to be clarified by prospective studies.
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Affiliation(s)
- Deepa Magge
- Division of Surgical Oncology, Koch Regional Perfusion Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lekshmi Ramalingam
- Division of Surgical Oncology, Koch Regional Perfusion Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Yongli Shuai
- The University of Pittsburgh Cancer Institute Biostatistics Facility, Pittsburgh, Pennsylvania
| | - Robert P Edwards
- Division of Surgical Oncology, Koch Regional Perfusion Center, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - James F Pingpank
- Division of Surgical Oncology, Koch Regional Perfusion Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Steven S Ahrendt
- Division of Surgical Oncology, Koch Regional Perfusion Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Matthew P Holtzman
- Division of Surgical Oncology, Koch Regional Perfusion Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Herbert J Zeh
- Division of Surgical Oncology, Koch Regional Perfusion Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - David L Bartlett
- Division of Surgical Oncology, Koch Regional Perfusion Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Haroon A Choudry
- Division of Surgical Oncology, Koch Regional Perfusion Center, University of Pittsburgh, Pittsburgh, Pennsylvania
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1st Evidence-based Italian consensus conference on cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinosis from ovarian cancer. TUMORI JOURNAL 2017; 103:525-536. [PMID: 28430350 DOI: 10.5301/tj.5000623] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2017] [Indexed: 12/11/2022]
Abstract
Ovarian cancer (OC) remains relatively rare, although it is among the top 4 causes of cancer death for women younger than 50. The aggressive nature of the disease and its often late diagnosis with peritoneal involvement have an impact on prognosis. The current scientific literature presents ambiguous or uncertain indications for management of peritoneal carcinosis (PC) from OC, both owing to the lack of sufficient scientific data and their heterogeneity or lack of consistency. Therefore, the Italian Society of Surgical Oncology (SICO), the Italian Society of Obstetrics and Gynaecology, the Italian Association of Hospital Obstetricians and Gynaecologists, and the Italian Association of Medical Oncology conducted a multidisciplinary consensus conference (CC) on management of advanced OC presenting with PC during the SICO annual meeting in Naples, Italy, on September 10-11, 2015. An expert committee developed questions on diagnosis and staging work-up, indications, and procedural aspects for peritonectomy, systemic chemotherapy, and hyperthermic intraperitoneal chemotherapy for PC from OC. These questions were provided to 6 invited speakers who answered with an evidence-based report. Each report was submitted to a jury panel, representative of Italian experts in the fields of surgical oncology, gynecology, and medical oncology. The jury panel revised the reports before and after the open discussion during the CC. This article is the final document containing the clinical evidence reports and statements, revised and approved by all the authors before submission.
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Coccolini F, Acocella F, Morosi L, Brizzola S, Ghiringhelli M, Ceresoli M, Davoli E, Ansaloni L, D'Incalci M, Zucchetti M. High Penetration of Paclitaxel in Abdominal Wall of Rabbits after Hyperthermic Intraperitoneal Administration of Nab-Paclitaxel Compared to Standard Paclitaxel Formulation. Pharm Res 2017; 34:1180-1186. [PMID: 28247168 DOI: 10.1007/s11095-017-2132-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 02/20/2017] [Indexed: 01/30/2023]
Abstract
PURPOSE Paclitaxel (PTX) is currently used in combination with cisplatin for Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for the treatment of peritoneal carcinomatosis. Albumin-bound PTX is a promising new drug for HIPEC because of its easy solubility in aqueous perfusion medium and possibly because of the tendency of albumin to cross physiological barriers and accumulate in tumor tissue. METHODS We tested the feasibility of using nab-paclitaxel in rabbits treated by HIPEC for 60 min compared with the classical formulation at an equivalent PTX dose. Samples of perfusate and blood were collected at different time points and peritoneal tissues were collected at the end of perfusion. PTX concentrations were determined by HPLC. The depth of paclitaxel penetration through the peritoneal barrier was assessed by mass spectrometry imaging. RESULTS PTX after nab-paclitaxel treatment penetrated up to 0.63 mm in the peritoneal wall, but after CRE-paclitaxel, it was not detectable in the peritoneum. Moreover, the peritoneal concentration after nab-paclitaxel was five times that after paclitaxel classical formulation. Despite the high levels reached in the peritoneum, systemic exposure of PTX was low. CONCLUSIONS Our results show that nab-paclitaxel penetrates into the abdominal wall better than CRE-paclitaxel, in terms of effective penetration and peritoneal tissue concentration.
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Affiliation(s)
- Federico Coccolini
- General, Emergency and Trauma Surgery Department Papa Giovanni XXIII hospital, Bergamo, Italy
| | - Fabio Acocella
- Dipartimento di Scienze Veterinarie per la Salute, la Produzione Animale e la Sicurezza Alimentare, Università degli Studi di Milano, Milan, Italy
| | - Lavinia Morosi
- Oncology Department, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
| | - Stefano Brizzola
- Dipartimento di Scienze Veterinarie per la Salute, la Produzione Animale e la Sicurezza Alimentare, Università degli Studi di Milano, Milan, Italy
| | - Matteo Ghiringhelli
- Dipartimento di Scienze Veterinarie per la Salute, la Produzione Animale e la Sicurezza Alimentare, Università degli Studi di Milano, Milan, Italy
| | - Marco Ceresoli
- General, Emergency and Trauma Surgery Department Papa Giovanni XXIII hospital, Bergamo, Italy
| | - Enrico Davoli
- Mass Spectrometry Laboratory, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Luca Ansaloni
- General, Emergency and Trauma Surgery Department Papa Giovanni XXIII hospital, Bergamo, Italy
| | - Maurizio D'Incalci
- Oncology Department, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Massimo Zucchetti
- Oncology Department, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
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Giri S, Shah SH, Batra Modi K, Rajappa SK, Shukla H, Shrestha E, Jain V, Sekhon R, Rawal S. Factors Affecting Perioperative Outcomes After CRS and HIPEC for Advanced and Recurrent Ovarian Cancer: A Prospective Single Institutional Study. J Gynecol Surg 2017. [DOI: 10.1089/gyn.2016.0077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Shveta Giri
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Swati Hb Shah
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Kanika Batra Modi
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Suhas K. Rajappa
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Himanshu Shukla
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Eliza Shrestha
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Vandana Jain
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Rupinder Sekhon
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Sudhir Rawal
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
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Rancoule C, Guy JB, Vallard A, Ben Mrad M, Rehailia A, Magné N. [50th anniversary of cisplatin]. Bull Cancer 2016; 104:167-176. [PMID: 27989629 DOI: 10.1016/j.bulcan.2016.11.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 11/06/2016] [Accepted: 11/12/2016] [Indexed: 01/08/2023]
Abstract
We have just celebrated the 50th anniversary of cisplatin cytotoxic potential discovery. It is time to take stock… and it seems mainly positive. This drug, that revolutionized the treatment of many cancer types, continues to be the most widely prescribed chemotherapy. Despite significant toxicities, resistance mechanisms associated with treatment failures, and unresolved questions about its mechanism of action, the use of this cytotoxic agent remains unwavering. The interest concerning this "old" invincible drug has not yet abated. Indeed many research axes are in the news. New platinum salts agents are tested, new cisplatin formulations are developed to target tumor cells more efficiently, and new combinations are established to increase the cytotoxic potency of cisplatin or overcome the resistance mechanisms.
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Affiliation(s)
- Chloé Rancoule
- Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez, France; CNRS UMR 5822, laboratoire de radiobiologie cellulaire et moléculaire de Lyon Sud, 165, chemin du Grand-Revoyet, BP 12, 69921 Oullins cedex, France
| | - Jean-Baptiste Guy
- Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez, France; CNRS UMR 5822, laboratoire de radiobiologie cellulaire et moléculaire de Lyon Sud, 165, chemin du Grand-Revoyet, BP 12, 69921 Oullins cedex, France
| | - Alexis Vallard
- Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez, France
| | - Majed Ben Mrad
- Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez, France
| | - Amel Rehailia
- Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez, France
| | - Nicolas Magné
- Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez, France; CNRS UMR 5822, laboratoire de radiobiologie cellulaire et moléculaire de Lyon Sud, 165, chemin du Grand-Revoyet, BP 12, 69921 Oullins cedex, France.
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Wu HT, Yang XJ, Huang CQ, Sun JH, Ji ZH, Peng KW, Zhang Q, Li Y. Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy with lobaplatin and docetaxel improves survival for patients with peritoneal carcinomatosis from abdominal and pelvic malignancies. World J Surg Oncol 2016; 14:246. [PMID: 27633880 PMCID: PMC5025634 DOI: 10.1186/s12957-016-1004-4] [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] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 09/08/2016] [Indexed: 12/22/2022] Open
Abstract
Background This work was to evaluate the perioperative safety and efficacy of cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) with lobaplatin and docetaxel in patients with peritoneal carcinomatosis (PC) from gastrointestinal and gynecological cancers. Methods Patients were treated by CRS + HIPEC with lobaplatin 50 mg/m2 and docetaxel 60 mg/m2 in 6000 mL of normal saline at 43 ± 0.5 °C for 60 min. Vital signs were recorded for 6 days after CRS + HIPEC procedures. Perioperative serious adverse events (SAE), hematological, hepatic, renal, and electrolytes parameters, the changes in serum tumor markers (TM) before and after operation, patient recovery, and overall survival (OS) were analyzed. Results One hundred consecutive PC patients underwent 105 CRS + HIPEC procedures and postoperative chemotherapy. The median CRS + HIPEC duration was 463 (range, 245–820) min, and the highest temperature and heart rate during six postoperative days were 38.6 °C (median 37.5 °C) and 124 bpm (median 100 bpm), respectively. The 30-day perioperative SAE occurred in 16 (15.2 %) and mortality occurred in 2 (1.9 %) patients. Most routine blood laboratory tests at 1 week after surgery turned normal. Among 82 cases with increased preoperative TM CEA, CA125, and CA199, 71 cases had TM levels reduced or turned normal. Median time to nasogastric tube removal was 5 (range, 3–23) days, to liquid food intake 6 (range, 4–24) days, and to abdominal suture removal 15 (range, 10–30) days. At the median follow-up of 19.7 (range, 7.5–89.2) months, the median OS was 24.2 (95 % CI, 15.0–33.4) months, and the 1-, 3-, and 5-year OS rates were 77.5, 32.5, and 19.8 %, respectively. Univariate analysis identified five independent prognostic factors on OS: the origin of PC, peritoneal cancer index, completeness of CRS, cycles of adjuvant chemotherapy, and SAE. Conclusions CRS + HIPEC with lobaplatin and docetaxel to treat PC is a feasible procedure with acceptable safety and can prolong the survival in selected patients with PC. Trial registration ClinicalTrials.gov, NCT00454519
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Affiliation(s)
- Hai-Tao Wu
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital Affiliated to the Capital Medical University, No 10 Tieyi Road, Yangfangdian, Haidian District, Beijing, 100038, China.,Department of Oncology, Zhongnan Hospital Wuhan University, Hubei Key Laboratory of Tumor Biological Behaviors and Hubei Cancer Clinical Study Center, Wuhan, 430071, China
| | - Xiao-Jun Yang
- Department of Oncology, Zhongnan Hospital Wuhan University, Hubei Key Laboratory of Tumor Biological Behaviors and Hubei Cancer Clinical Study Center, Wuhan, 430071, China
| | - Chao-Qun Huang
- Department of Oncology, Zhongnan Hospital Wuhan University, Hubei Key Laboratory of Tumor Biological Behaviors and Hubei Cancer Clinical Study Center, Wuhan, 430071, China
| | - Jian-Hua Sun
- Department of Oncology, Zhongnan Hospital Wuhan University, Hubei Key Laboratory of Tumor Biological Behaviors and Hubei Cancer Clinical Study Center, Wuhan, 430071, China
| | - Zhong-He Ji
- Department of Oncology, Zhongnan Hospital Wuhan University, Hubei Key Laboratory of Tumor Biological Behaviors and Hubei Cancer Clinical Study Center, Wuhan, 430071, China
| | - Kai-Wen Peng
- Department of Oncology, Zhongnan Hospital Wuhan University, Hubei Key Laboratory of Tumor Biological Behaviors and Hubei Cancer Clinical Study Center, Wuhan, 430071, China
| | - Qian Zhang
- Department of Oncology, Zhongnan Hospital Wuhan University, Hubei Key Laboratory of Tumor Biological Behaviors and Hubei Cancer Clinical Study Center, Wuhan, 430071, China
| | - Yan Li
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital Affiliated to the Capital Medical University, No 10 Tieyi Road, Yangfangdian, Haidian District, Beijing, 100038, China. .,Department of Oncology, Zhongnan Hospital Wuhan University, Hubei Key Laboratory of Tumor Biological Behaviors and Hubei Cancer Clinical Study Center, Wuhan, 430071, China.
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Coccolini F, Celotti A, Ceresoli M, Montori G, Marini M, Catena F, Ansaloni L. Hyperthermic intraperitoneal chemotherapy (HIPEC) and neoadjuvant chemotherapy as prophylaxis of peritoneal carcinosis from advanced gastric cancer-effects on overall and disease free survival. J Gastrointest Oncol 2016; 7:523-9. [PMID: 27563441 DOI: 10.21037/jgo.2016.06.05] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The possibility to enlarge criteria for intra-peritoneal chemotherapy (IPC) to all patients at high-risk to develop peritoneal carcinosis (i.e., with serosal invasion) is still discussed. METHODS Retrospective case-control study. Three-groups: advanced-gastric-cancer (AGC) (pT4) without proven carcinosis: prophylactic group (PG), those with PC: treatment group (TG), AGC (pT3-pT4) operated without hyperthermic intraperitoneal chemotherapy (HIPEC), surgery alone group (SG T3, SG T4). RESULTS Forty four patients. 26 (59.1%) were male. Sixteen (36%) patients underwent 16 HIPEC: 6 (38%) had AGC (pT4) without PC (PG), 10 (62%) had carcinosis (TG), 28 were operated without HIPEC (SG T3, SG T4). The mean disease free survival (DFS): TG: 7.7 months, SG T4: 21.6 months, SG T3: 27.7 months, PG: 34.5 months. DFS was significantly different for TG (P=0.03, P=0.021, P=0.013 respectively). The mean OS TG: 10 months, SG T4: 27.1 months, SG T3: 28.2 months, PG: 34.6 months. OS was significantly different for TG (P=0.04, P=0.04, P=0.045 respectively). Severe complication rate: TG: 60%, PG: 16.7%, SG T3: 7.7% and SG T4: 25% (P=0.035). Length-of-stay differs significantly (P=0.003); overall length-of-stay: 19.41 days [standard deviation (SD) ±15.03]; TG: 33.01 (SD ±23.08), PG: 20.17 (SD ±6.21), SG T3: 11.33 (SD ±3.22), SG T4: 15.36 (SD ±5.48). CONCLUSIONS Prophylactic intraperitoneal chemotherapy associated to neoadjuvant chemotherapy increases the DFS and OS in patients with AGC without carcinosis. More data are needed in order to confirm these results.
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Affiliation(s)
- Federico Coccolini
- General Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Andrea Celotti
- General Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Marco Ceresoli
- General Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Giulia Montori
- General Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Michele Marini
- General Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Fausto Catena
- General and Emergency surgery, Parma Maggiore Hospital, Parma, Italy
| | - Luca Ansaloni
- General Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
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Woodley-Cook J, Tarulli E, Tan KT, Rajan DK, Simons ME. Safety and Effectiveness of Percutaneously Inserted Peritoneal Ports Compared to Surgically Inserted Ports in a Retrospective Study of 87 Patients with Ovarian Carcinoma over a 10-Year Period. Cardiovasc Intervent Radiol 2016; 39:1629-1635. [PMID: 27464996 DOI: 10.1007/s00270-016-1433-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 07/20/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Placement of peritoneal ports has become a favorable technique for direct chemotherapy infusion in treating peritoneal metastases from ovarian cancer. We aim to outline an approach to the percutaneous insertion of peritoneal ports and to characterize success and complication rates compared to surgically inserted ports. MATERIALS AND METHODS Retrospective analysis was collected from 87 patients who had peritoneal port insertion (28 inserted surgically and 59 percutaneously) for treatment of peritoneal metastases from ovarian cancer from July 2004 to July 2014. Complications were classified according to the SIR Clinical Practice Guidelines as major or minor. RESULTS Technical success rates for surgically and percutaneously inserted ports were 100 and 96.7 %, respectively (p = 0.44), with the two percutaneous failures successful at a later date. There were no major complications in either group. Minor complication rates for surgically versus percutaneously inserted ports were 46.4 versus 22.0 %, respectively (p = 0.02). The infection rate for surgically inserted versus percutaneously inserted ports was 14.3 and 0 %, respectively (p = 0.002). The relative risk of developing a complication from percutaneous peritoneal port insertion without ascites was 3.4 (p = 0.04). For percutaneously inserted ports, the mean in-room procedure time was 81 ± 1.3 min and mean fluoroscopy time was 5.0 ± 4.5 min. CONCLUSION Percutaneously inserted peritoneal ports are a safe alternative to surgically inserted ports, demonstrating similar technical success and lower complication rates.
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Affiliation(s)
- Joel Woodley-Cook
- Vascular and Interventional Radiology, Department of Diagnostic Imaging, The Scarborough Hospital, 3030 Lawrence Street East, Scarborough, ON, M1P 2T7, Canada.
| | - Emidio Tarulli
- Vascular and Interventional Radiology, Department of Medical Imaging, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Kong T Tan
- Vascular and Interventional Radiology, Department of Medical Imaging, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Dheeraj K Rajan
- Vascular and Interventional Radiology, Department of Medical Imaging, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Martin E Simons
- Vascular and Interventional Radiology, Department of Medical Imaging, University Health Network, University of Toronto, Toronto, ON, Canada
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Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy with lobaplatin and docetaxel to treat synchronous peritoneal carcinomatosis from gastric cancer: Results from a Chinese center. Eur J Surg Oncol 2016; 42:1024-34. [DOI: 10.1016/j.ejso.2016.04.053] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 04/05/2016] [Accepted: 04/18/2016] [Indexed: 12/29/2022] Open
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