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Raj H, Keerthi MSS, Palaniappan R, Prakash U, Dhanushkodi M, Ganesan TS. Phase 2 non-randomised trial of secondary cytoreduction and hyperthermic intraperitoneal chemotherapy in recurrent platinum-sensitive ovarian cancer. Ecancermedicalscience 2021; 15:1260. [PMID: 34567245 PMCID: PMC8426017 DOI: 10.3332/ecancer.2021.1260] [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: 04/11/2021] [Indexed: 11/07/2022] Open
Abstract
Background The role of secondary cytoreduction with hyperthermic intraperitoneal chemotherapy (HIPEC) is not clearly defined in recurrent platinum-sensitive ovarian cancer (PSOC). There is a paucity of studies on secondary cytoreduction with HIPEC in PSOC from developing countries like India. This study was done to assess the feasibility and safety of secondary cytoreduction and HIPEC in recurrent PSOC. Methods This was a prospective, non-randomised, open-label, phase 2 trial of secondary cytoreduction and HIPEC (Cisplatin 75 mg/m2 43°C over 60 minutes) in patients with recurrent platinum-sensitive epithelial carcinoma of ovary/fallopian tube/peritoneum done in a tertiary cancer centre from February 2016 to August 2019. The primary outcome was to assess the overall survival (OS) and the secondary outcomes were to assess the progression-free survival (PFS) and toxicity. Results Twenty-seven patients were screened and among them, 15 patients were included in this analysis with a median follow-up of 25 months. The mean cancer antigen (CA) 125 at the time of recurrence was 149 U/mL (range: 10–2,030 U/mL) and the median platinum-free interval was 21 months. The perioperative chemotherapy used was paclitaxel + carboplatin 53.3% (8/15), liposomal doxorubicin + carboplatin 40% (6/15) and none 6.5% (1/15). The median Peritoneal Carcinomatosis Index score was 8 (range: 3–25). The Clavien Dindo score was I, II and III in 6.7%, 26.7% and 13.3% patients, respectively. Recurrence was radiological and biochemical in 60% (9/15) and 7% (1/15), respectively. The most common site of recurrence was intra-abdominal (peritoneal). The median PFS and OS were 15 months (range: 0–34) and 26 months (range: 23–29), respectively. The grade 3 or 4 toxicity was 40%. Conclusion Secondary cytoreduction with HIPEC is feasible and safe in recurrent PSOC. Conclusive evidence that secondary cytoreduction with HIPEC is essential awaits the results from ongoing randomised controlled trials.
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Affiliation(s)
- Hemanth Raj
- Department of Surgical Oncology, Cancer Institute (WIA), 38, Sardar Patel Road, Chennai 600036, Tamil Nadu, India.,Hemanth Raj and Marri Sri Santosh Keerthi contributed equally
| | - Marri Sri Santosh Keerthi
- Department of Surgical Oncology, Cancer Institute (WIA), 38, Sardar Patel Road, Chennai 600036, Tamil Nadu, India.,Hemanth Raj and Marri Sri Santosh Keerthi contributed equally
| | - Ravisankar Palaniappan
- Department of Surgical Oncology, Sri Venkateshwaraa Medical College Hospital and Research Centre, Puducherry 605102, India
| | - Ujwala Prakash
- Department of Surgical Oncology, Cancer Institute (WIA), 38, Sardar Patel Road, Chennai 600036, Tamil Nadu, India
| | - Manikandan Dhanushkodi
- Department of Medical Oncology, Cancer Institute (WIA), 38, Sardar Patel Road, Chennai 600036, Tamil Nadu, India.,https://orcid.org/0000-0002-8192-3856
| | - Trivadi S Ganesan
- Department of Medical Oncology, Cancer Institute (WIA), 38, Sardar Patel Road, Chennai 600036, Tamil Nadu, India
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Beeharry MK, Zhu ZL, Liu WT, Yao XX, Yan M, Zhu ZG. Prophylactic HIPEC with radical D2 gastrectomy improves survival and peritoneal recurrence rates for locally advanced gastric cancer: personal experience from a randomized case control study. BMC Cancer 2019; 19:932. [PMID: 31533660 PMCID: PMC6751672 DOI: 10.1186/s12885-019-6125-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 09/03/2019] [Indexed: 02/07/2023] Open
Abstract
Background To investigate the implications of prophylactic intraoperative Hyperthermic Intraperitoneal Chemotherapy (HIPEC) with D2 radical gastrectomy for locally advanced Gastric Cancer (AGC) in a randomized case control study. Method Eighty consecutive patients with locally AGC were randomly separated into 2 groups: HIPEC group (Curative Resection + intraoperative HIPEC with cisplatin 50 mg/m2 at 42.0 ± 1.0 °C for 60 min) and Control group (Curative Resection only). Intraoperative and post-operative events, clinical recovery, morbidity and the disease-free survival (DFS) rates were closely monitored. Results Faster recovery of bowel function (43 ± 5 h vs 68 ± 7, P < 0.05) and shorter postoperative stay (8d vs 14d, P < 0.05) were noted in the HIPEC group. Among the 40 HIPEC group patients, the highest intracranial temperature recorded during the procedure was 38.2 °C but the patient made an eventless recovery. Mild renal dysfunction, hyperbilirubinemia and mild liver dysfunction were recorded in the HIPEC group but their incidences were found to be statistically insignificant when compared with the control group (P > 0.05). The 3 year DFS rate analysis showed that the prophylactic HIPEC group had a higher DFS rate (93% vs 65%, P = 0.0054). The peritoneal recurrence rate was lower in the HIPEC group (3% vs 23%, P < 0.05). Conclusion Prophylactic HIPEC with radical D2 Gastrectomy improves survival and peritoneal recurrence rates for AGC with favorable post-operative recovery at low and acceptable morbidity.
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Affiliation(s)
- Maneesh Kumarsing Beeharry
- Department of Surgery, Ruijin Hospital affiliated Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Zheng-Lun Zhu
- Department of Surgery, Ruijin Hospital affiliated Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Wen-Tao Liu
- Department of Surgery, Ruijin Hospital affiliated Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Xue-Xin Yao
- Department of Surgery, Ruijin Hospital affiliated Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
| | - Min Yan
- Department of Surgery, Ruijin Hospital affiliated Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Zheng-Gang Zhu
- Department of Surgery, Ruijin Hospital affiliated Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
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Rana AKS, Agarwal N, Dutta S, Dokania MK, Goyal H. A Modified Low-Cost Technique of Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Two Patients: a Solution for Pseudomyxoma Peritonei in the Indian Scenario? J Gastrointest Cancer 2018; 50:983-990. [PMID: 30140971 DOI: 10.1007/s12029-018-0161-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Anil Kumar Singh Rana
- Department of Surgery, Renal Transplant Unit, Postgraduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia Hospital (RMLH), Baba Kharak Singh Marg, Delhi, 110001, India
| | - Nitin Agarwal
- Department of Surgery, Renal Transplant Unit, Postgraduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia Hospital (RMLH), Baba Kharak Singh Marg, Delhi, 110001, India.
| | - Sushant Dutta
- Department of Surgery, Renal Transplant Unit, Postgraduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia Hospital (RMLH), Baba Kharak Singh Marg, Delhi, 110001, India
| | - Manoj Kumar Dokania
- Department of Surgery, Renal Transplant Unit, Postgraduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia Hospital (RMLH), Baba Kharak Singh Marg, Delhi, 110001, India
| | - Himank Goyal
- Department of Surgery, Renal Transplant Unit, Postgraduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia Hospital (RMLH), Baba Kharak Singh Marg, Delhi, 110001, India
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Rodríguez Silva C, Moreno Ruiz FJ, Bellido Estévez I, Carrasco Campos J, Titos García A, Ruiz López M, González Poveda I, Toval Mata JA, Mera Velasco S, Santoyo Santoyo J. Are there intra-operative hemodynamic differences between the Coliseum and closed HIPEC techniques in the treatment of peritoneal metastasis? A retrospective cohort study. World J Surg Oncol 2017; 15:51. [PMID: 28222738 PMCID: PMC5320712 DOI: 10.1186/s12957-017-1119-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 02/08/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Although two main methods of intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) are currently accepted, the superiority of one over the other has not yet been demonstrated. The purpose of this study was to determine whether there are hemodynamic and temperature differences between patients who received HIPEC in two different techniques, open versus closed abdomen. METHODS This retrospective study was conducted in our center between 2011-2015 in 30 patients who underwent surgery for peritoneal carcinomatosis secondary to colorectal cancer, in whom cytoreduction and HIPEC were performed by the Coliseum (15) or closed techniques (15). The main end points were morbidity, mortality, hemodynamic changes, and abdominal temperature. The comparative analysis of quantitative variables at different times was done with the parametric repeated measure ANOVA for those variables that fulfilled the suppositions of normality and independence and the Friedman non-parametric test for the variables that did not fulfill either of these suppositions. RESULTS There were no deaths in either group. The incidence of postoperative complications in the Coliseum group was 53% (8 patients), grade II-III. The incidence of complications in the closed group was 13% (2 patients), grade II-III. The intra-operative conditions regarding the systolic and diastolic pressures were more stable using the closed abdomen technique (but not significantly so). We found statistically significant differences in abdominal temperature in favor of the closed technique (p = 0.009). CONCLUSIONS Both HIPEC procedures are similar. In our series, the closed technique resulted in a more stable intra-abdominal temperature.
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Affiliation(s)
- Cristina Rodríguez Silva
- Universidad de Málaga, Departamento de Farmacología, Servicio de Cirugía General, Digestiva y Trasplantes, Hospital Regional Universitario de Málaga, Avda Carlos Haya, 29020, Malaga, Spain.
| | - Francisco Javier Moreno Ruiz
- Universidad de Málaga, Departamento de Farmacología, Servicio de Cirugía General, Digestiva y Trasplantes, Hospital Regional Universitario de Málaga, Avda Carlos Haya, 29020, Malaga, Spain
| | - Inmaculada Bellido Estévez
- Universidad de Málaga, Departamento de Farmacología, Servicio de Cirugía General, Digestiva y Trasplantes, Hospital Regional Universitario de Málaga, Avda Carlos Haya, 29020, Malaga, Spain
| | - Joaquin Carrasco Campos
- Universidad de Málaga, Departamento de Farmacología, Servicio de Cirugía General, Digestiva y Trasplantes, Hospital Regional Universitario de Málaga, Avda Carlos Haya, 29020, Malaga, Spain
| | - Alberto Titos García
- Universidad de Málaga, Departamento de Farmacología, Servicio de Cirugía General, Digestiva y Trasplantes, Hospital Regional Universitario de Málaga, Avda Carlos Haya, 29020, Malaga, Spain
| | - Manuel Ruiz López
- Universidad de Málaga, Departamento de Farmacología, Servicio de Cirugía General, Digestiva y Trasplantes, Hospital Regional Universitario de Málaga, Avda Carlos Haya, 29020, Malaga, Spain
| | - Ivan González Poveda
- Universidad de Málaga, Departamento de Farmacología, Servicio de Cirugía General, Digestiva y Trasplantes, Hospital Regional Universitario de Málaga, Avda Carlos Haya, 29020, Malaga, Spain
| | - Jose Antonio Toval Mata
- Universidad de Málaga, Departamento de Farmacología, Servicio de Cirugía General, Digestiva y Trasplantes, Hospital Regional Universitario de Málaga, Avda Carlos Haya, 29020, Malaga, Spain
| | - Santiago Mera Velasco
- Universidad de Málaga, Departamento de Farmacología, Servicio de Cirugía General, Digestiva y Trasplantes, Hospital Regional Universitario de Málaga, Avda Carlos Haya, 29020, Malaga, Spain
| | - Julio Santoyo Santoyo
- Universidad de Málaga, Departamento de Farmacología, Servicio de Cirugía General, Digestiva y Trasplantes, Hospital Regional Universitario de Málaga, Avda Carlos Haya, 29020, Malaga, Spain
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Beeharry MK, Liu WT, Yao XX, Yan M, Zhu ZG. A critical analysis of the cytoreductive surgery with hyperthermic intraperitoneal chemotherapy combo in the clinical management of advanced gastric cancer: an effective multimodality approach with scope for improvement. Transl Gastroenterol Hepatol 2016; 1:77. [PMID: 28138643 DOI: 10.21037/tgh.2016.08.05] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 08/22/2016] [Indexed: 12/16/2022] Open
Abstract
Peritoneal carcinomatosis (PC) is manifested in up to 40% of gastric cancer (GC) patients, after which their 5-year survival drops to less than 5%. The currently most acceptable treatment option for advanced GC (AGC) is systemic chemo and radio therapies with however generally very unsatisfying results and this led to a resurgence of interest in regional therapies like cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Small trials have indicated an association with prolonged survival when applying this technique to AGC manifesting with PC. High procedure-related morbidity and mortality associated with the CRS-HIPEC approach have however brought by a polemic on the merits of the latter: with the advent of regulatory approval of more effective as well as novel, more personalized treatment options in AGC, along with advances in tailoring investigational agents specifically for peritoneal delivery, there clearly is a need to outline the appropriate role of CRS-HIPEC in this disease. In a clear objective to improve the therapeutic efficiency of HIPEC, there have been immense developments in the technical aspects of this technology including the use of nanotechnology in more precise drug delivery systems (DDS) or choice of more efficient drugs such as gene-target technology, laparoscopy and so on. Henceforth, in this review, we will be highlighting the past and current status of the CRS + HIPEC procedure, shedding light on the pros and cons in order to boost up the efficiency of this multimodality approach.
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Affiliation(s)
- Maneesh K Beeharry
- Department of Surgery, Rui Jin Hospital, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Wen-Tao Liu
- Department of Surgery, Rui Jin Hospital, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Xue-Xin Yao
- Department of Surgery, Rui Jin Hospital, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Min Yan
- Department of Surgery, Rui Jin Hospital, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Zheng-Gang Zhu
- Department of Surgery, Rui Jin Hospital, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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