1
|
Iglesias Gómez C, Blanco Lorenzo V, Garcia Dominguez R, García Carbonero I, Feliciangeli E, Galvan Ruiz S, Gómez de Liaño A, Perez Valderrama B, Rodriguez Sanchez A, Sánchez-Escribano R, Suarez Rodriguez C, Lázaro Quintela M, Gallardo Diaz E, Guma I Padro J, Puente J, Villa Guzman J, García Sanchez J, Martinez Kareaga M, Beato Zambrano M, Molina-Cerrillo J. 1474P Prognostic value of PD-L1 in patients with metastatic renal cell carcinoma (mRCC) treated with antiangiogenic first line drugs (PROANG-SOGUG study). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
2
|
Jimenez-Fonseca P, Carmona-Bayonas A, Lamarca A, Barriuso J, Castaño A, Benavent M, Alonso V, Riesco MDC, Alonso-Gordoa T, Custodio A, Sanchez Canovas M, Hernando J, López C, La Casta A, Fernandez Montes A, Marazuela M, Crespo G, Diaz JA, Feliciangeli E, Gallego J, Llanos M, Segura A, Vilardell F, Percovich JC, Grande E, Capdevila J, Valle J, Garcia-Carbonero R. External Validity of Somatostatin Analogs Trials in Advanced Neuroendocrine Neoplasms: The GETNE-TRASGU Study. Neuroendocrinology 2022; 112:88-100. [PMID: 33508849 DOI: 10.1159/000514808] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/27/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Somatostatin analogs (SSA) prolong progression-free survival (PFS) in patients with well-differentiated gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs). However, the eligibility criteria in randomized clinical trials (RCTs) have been restricted, which contrasts with the vast heterogeneity found in NENs. METHODS We identified patients with well-differentiated (Ki-67% ≤20%), metastatic GEP-NENs treated in first line with SSA monotherapy from the Spanish R-GETNE registry. The therapeutic effect was evaluated using a Bayesian Cox model. The objective was to compare survival-based outcomes from real-world clinical practice versus RCTs. RESULTS The dataset contained 535 patients with a median age of 62 years (range: 26-89). The median Ki-67% was 4 (range: 0-20). The most common primary tumor sites were as follows: midgut, 46%; pancreas, 34%; unknown primary, 10%; and colorectal, 10%. Half of the patients received octreotide LAR (n = 266) and half, lanreotide autogel (n = 269). The median PFS was 28.0 months (95% CI: 22.1-32.0) for octreotide versus 30.1 months (95% CI: 23.1-38.0) for lanreotide. The overall hazard ratio for lanreotide versus octreotide was 0.90 (95% credible interval: 0.71-1.12). The probability of effect sizes >30% with lanreotide versus octreotide was 2 and 6% for midgut and foregut NENs, respectively. CONCLUSION Our study evaluated the external validity of RCTs examining SSAs in the real world, as well as the main effect-modifying factors (progression status, symptoms, tumor site, specific metastases, and analytical data). Our results indicate that both octreotide LAR and lanreotide autogel had a similar effect on PFS. Consequently, both represent valid alternatives in patients with well-differentiated, metastatic GEP-NENs.
Collapse
Affiliation(s)
- Paula Jimenez-Fonseca
- Medical Oncology Department, Hospital Universitario Central de Asturias, ISPA, Oviedo, Spain
| | - Alberto Carmona-Bayonas
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain
| | - Angela Lamarca
- Medical Oncology Department, The Christie NHS Foundation Trust, ENETS Centre of Excellence, Manchester, United Kingdom
- Division of Cancer Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Jorge Barriuso
- Medical Oncology Department, The Christie NHS Foundation Trust, ENETS Centre of Excellence, Manchester, United Kingdom
- Division of Cancer Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Angel Castaño
- Pathology Department, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Marta Benavent
- Medical Oncology Department, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain
| | - Vicente Alonso
- Medical Oncology Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Maria Del Carmen Riesco
- Medical Oncology Department, Hospital Universitario Doce de Octubre, IIS imas12, UCM, CNIO, CIBERONC, Madrid, Spain
| | - Teresa Alonso-Gordoa
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Ana Custodio
- Medical Oncology Department, Hospital Universitario La Paz, CIBERONC CB16/12/00398, Madrid, Spain
| | - Manuel Sanchez Canovas
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain
| | - Jorge Hernando
- Medical Oncology Department, Hospital Universitario Vall d'Hebron, Vall Hebron Institute of Oncology (VHIO), Autonomous University of Barcelona, Barcelona, Spain
| | - Carlos López
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Adelaida La Casta
- Medical Oncology Department, Hospital Universitario Donostia, San Sebastián, Spain
| | - Ana Fernandez Montes
- Medical Oncology Department, Complexo Hospitalario Universitario de Ourense, Ourense, Spain
| | - Mónica Marazuela
- Endocrinology Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - Guillermo Crespo
- Medical Oncology Department, Complejo Asistencial Universitario de Burgos, Burgos, Spain
| | - Jose Angel Diaz
- Endocrinology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Eduardo Feliciangeli
- Medical Oncology Department, Hospital Universitario Santa Lucia, Cartagena, Spain
| | - Javier Gallego
- Medical Oncology Department, Hospital General Universitario de Elche, Elche, Spain
| | - Marta Llanos
- Medical Oncology Department, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain
| | - Angel Segura
- Medical Oncology Department, Hospital Universitario La Fe, Valencia, Spain
| | - Felip Vilardell
- Pathology Department, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | | | - Enrique Grande
- Medical Oncology Department, MD Anderson Cancer Center Madrid, Madrid, Spain
| | - Jaume Capdevila
- Medical Oncology Department, Hospital Universitario Vall d'Hebron, Vall Hebron Institute of Oncology (VHIO), Autonomous University of Barcelona, Barcelona, Spain
| | - Juan Valle
- Medical Oncology Department, The Christie NHS Foundation Trust, ENETS Centre of Excellence, Manchester, United Kingdom
- Division of Cancer Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Rocio Garcia-Carbonero
- Medical Oncology Department, Hospital Universitario Doce de Octubre, IIS imas12, UCM, CNIO, CIBERONC, Madrid, Spain
| |
Collapse
|
3
|
Carmona-Bayonas A, Jiménez-Fonseca P, Lamarca Á, Barriuso J, Castaño Á, Benavent M, Alonso V, Riesco-Martínez MDC, Alonso-Gordoa T, Custodio A, Sánchez Cánovas M, Hernando Cubero J, López C, Lacasta A, Fernández Montes A, Marazuela M, Crespo G, Escudero P, Diaz JÁ, Feliciangeli E, Gallego J, Llanos M, Segura Á, Vilardell F, Percovich JC, Grande E, Capdevila J, Valle JW, García-Carbonero R. Prediction of Progression-Free Survival in Patients With Advanced, Well-Differentiated, Neuroendocrine Tumors Being Treated With a Somatostatin Analog: The GETNE-TRASGU Study. J Clin Oncol 2019; 37:2571-2580. [PMID: 31390276 PMCID: PMC6768612 DOI: 10.1200/jco.19.00980] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Somatostatin analogs (SSAs) are recommended for the first-line treatment of most patients with well-differentiated, gastroenteropancreatic (GEP) neuroendocrine tumors; however, benefit from treatment is heterogeneous. The aim of the current study was to develop and validate a progression-free survival (PFS) prediction model in SSA-treated patients. PATIENTS AND METHODS We extracted data from the Spanish Group of Neuroendocrine and Endocrine Tumors Registry (R-GETNE). Patient eligibility criteria included GEP primary, Ki-67 of 20% or less, and first-line SSA monotherapy for advanced disease. An accelerated failure time model was developed to predict PFS, which was represented as a nomogram and an online calculator. The nomogram was externally validated in an independent series of consecutive eligible patients (The Christie NHS Foundation Trust, Manchester, United Kingdom). RESULTS We recruited 535 patients (R-GETNE, n = 438; Manchester, n = 97). Median PFS and overall survival in the derivation cohort were 28.7 (95% CI, 23.8 to 31.1) and 85.9 months (95% CI, 71.5 to 96.7 months), respectively. Nine covariates significantly associated with PFS were primary tumor location, Ki-67 percentage, neutrophil-to-lymphocyte ratio, alkaline phosphatase, extent of liver involvement, presence of bone and peritoneal metastases, documented progression status, and the presence of symptoms when initiating SSA. The GETNE-TRASGU (Treated With Analog of Somatostatin in Gastroenteropancreatic and Unknown Primary NETs) model demonstrated suitable calibration, as well as fair discrimination ability with a C-index value of 0.714 (95% CI, 0.680 to 0.747) and 0.732 (95% CI, 0.658 to 0.806) in the derivation and validation series, respectively. CONCLUSION The GETNE-TRASGU evidence-based prognostic tool stratifies patients with GEP neuroendocrine tumors receiving SSA treatment according to their estimated PFS. This nomogram may be useful when stratifying patients with neuroendocrine tumors in future trials. Furthermore, it could be a valuable tool for making treatment decisions in daily clinical practice.
Collapse
Affiliation(s)
- Alberto Carmona-Bayonas
- Hospital Universitario Morales Meseguer, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria, Murcia, Spain
| | | | - Ángela Lamarca
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Jorge Barriuso
- The Christie NHS Foundation Trust, Manchester, United Kingdom.,University of Manchester, Manchester, United Kingdom
| | - Ángel Castaño
- Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Marta Benavent
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla, Sevilla, Spain
| | | | | | | | - Ana Custodio
- Hospital Universitario La Paz, Centro de Investigación Biomédica en Red Cáncer, CB16/12/00398, Madrid, Spain
| | - Manuel Sánchez Cánovas
- Hospital Universitario Morales Meseguer, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria, Murcia, Spain
| | - Jorge Hernando Cubero
- Hospital Universitario Vall d'Hebron, Vall Hebron Institute of Oncology, Autonomous University of Barcelona, Barcelona, Spain
| | - Carlos López
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | | | | | | | - Pilar Escudero
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | | | | | - Marta Llanos
- Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain
| | | | | | | | | | - Jaume Capdevila
- Hospital Universitario Vall d'Hebron, Vall Hebron Institute of Oncology, Autonomous University of Barcelona, Barcelona, Spain
| | - Juan W Valle
- The Christie NHS Foundation Trust, Manchester, United Kingdom.,University of Manchester, Manchester, United Kingdom
| | - Rocío García-Carbonero
- Hospital Universitario Doce de Octubre, Universidad Complutense de Madrid, Centro Nacional de Investigaciones Oncológicas, Centro de Investigación Biomédica en Red Cáncer, Madrid, Spain
| |
Collapse
|
4
|
Fornovi Justo A, Palomares C, Martínez L, Ballester R, Parreño E, Martínez M, Salinero L, Feliciangeli E, Saura E. Obesity and its comorbidities. When nutritional intervention fails and bariatric surgery is successful. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
5
|
Lopez-Lopez V, Cascales-Campos P, Gil J, Frutos L, Andrade R, Fuster-Quiñonero M, Feliciangeli E, Gil E, Parrilla P. Use of 18 F-FDG PET/CT in the preoperative evaluation of patients diagnosed with peritoneal carcinomatosis of ovarian origin, candidates to cytoreduction and hipec. A pending issue. Eur J Radiol 2016; 85:1824-1828. [DOI: 10.1016/j.ejrad.2016.08.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 08/08/2016] [Accepted: 08/09/2016] [Indexed: 12/19/2022]
|
6
|
Cascales-Campos PA, López-López V, Muñoz-Casares FC, Feliciangeli E, Torres Melero J, Barrios P, Morales R, Ramos I, Ortega G, Camps B, González-Bayón L, Bretcha-Boix P, Farré-Alegre J, González-Moreno S, Gil J. Morbidity and mortality outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients aged 75 years and over: Spanish group of peritoneal cancer surgery (GECOP) multicenter study. Surg Oncol 2016; 25:111-6. [PMID: 27312037 DOI: 10.1016/j.suronc.2016.03.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 03/23/2016] [Accepted: 03/28/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of this study is to report the perioperative outcomes of cytoreductive surgery and hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) in patients ≥75 years from a Spanish multi-institutional experience. METHODS This multi-institutional retrospectively analyzed a prospectively collected clinical data from 10 Spanish hospitals that are part of the Spanish Group Peritoneal Cancer Surgery (GECOP). We assessed postoperative morbidity rates and performed univariate and multivariate analyses of factors associated with overall (grade I-IV) and major (grade III-IV) postoperative morbidity. RESULTS A total of 85 patients aged ≥75 years were included. Forty six postoperative adverse events were detected in 37 patients (43.5%). Twenty five complications in 20 patients (23.5%) were mild (grade I-II) and 16 complications in 12 patients (14.1%) were moderate-severe (grade III-IV). Five patients died in the first 90 days after the procedure (5.9%). After multivariate analysis, independent factors associated with postoperative complications were: PCI> 12 (OR: 4.14, 95% CI 1.22-14.12, p = 0.043) and the need for perioperative blood transfusion (OR: 14.91, 95% CI 3.87-57.46, p < 0.001). Regarding grade III-IV complications, after multivariate analysis, the presence of preoperative albumin levels <3.5 mgr/dl (OR: 9.15, 95% CI 1.38-60.57, p = 0.017), need for diaphragmatic peritonectomy procedures (OR: 11.32, 95% CI 1.40-91.32, p = 0.023) and perioperative blood transfusion (OR: 8.58, 95% CI 1.44-51.16, p = 0.018) were independent factors. CONCLUSIONS Cytoreductive surgery and performing HIPEC by experienced groups in selected patients aged ≥75 years can be performed with morbidity and mortality similar to that described in the literature.
Collapse
Affiliation(s)
- P A Cascales-Campos
- Hospital Clínico Universitario Virgen De La Arrixaca, Murcia, IMIB-Arrixaca, Murcia, Spain.
| | - V López-López
- Hospital Clínico Universitario Virgen De La Arrixaca, Murcia, IMIB-Arrixaca, Murcia, Spain
| | | | - E Feliciangeli
- Hospital Clínico Universitario Virgen De La Arrixaca, Murcia, IMIB-Arrixaca, Murcia, Spain
| | - J Torres Melero
- Hospital Universitario De Torrecárdenas, Almería, Andalucia, Spain
| | - P Barrios
- Hospital De Sant Joan De Espi Moises Broggi, Sant Joan De Espi, Cataluña, Spain
| | - R Morales
- Hospital Universitario Son Espases, Palma de Mayorca, Islas Baleares, Spain
| | - I Ramos
- Hospital De Sant Joan De Espi Moises Broggi, Sant Joan De Espi, Cataluña, Spain
| | - G Ortega
- Hospital Universitario De Fuenlabrada, Madrid, Spain
| | - B Camps
- Hospital General Universitario, Valencia, Valencia, Spain
| | | | - P Bretcha-Boix
- Hospital Quirón de Torrevieja, Alicante, Comunidad Valenciana, Spain
| | - J Farré-Alegre
- Hospital Quirón de Torrevieja, Alicante, Comunidad Valenciana, Spain
| | | | - J Gil
- Hospital Clínico Universitario Virgen De La Arrixaca, Murcia, IMIB-Arrixaca, Murcia, Spain
| |
Collapse
|
7
|
Cascales-Campos P, Gil J, Feliciangeli E, Parrilla P. HIPEC in ovarian cancer: Treatment of a new era or is it the end of the pipeline? Gynecol Oncol 2015; 139:363-8. [DOI: 10.1016/j.ygyno.2015.06.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 05/15/2015] [Accepted: 06/08/2015] [Indexed: 01/21/2023]
|
8
|
Cascales-Campos PA, Gil J, Feliciangeli E, Gil E, González-Gil A, López V, Ruiz-Pardo J, Nieto A, Parrilla JJ, Parrilla P. The role of hyperthermic intraperitoneal chemotherapy using paclitaxel in platinum-sensitive recurrent epithelial ovarian cancer patients with microscopic residual disease after cytoreduction. Ann Surg Oncol 2014; 22:987-93. [PMID: 25212832 DOI: 10.1245/s10434-014-4049-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND We analyzed the role of hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) on the microscopic component of the disease in patients with a first recurrence of platinum-sensitive ovarian cancer after complete cytoreduction (CCR). PATIENTS AND METHODS We analyzed the data of 54 patients who were operated on between January 2001 and July 2012 with the diagnosis of platinum-sensitive recurrent ovarian cancer. In all patients, it was possible to achieve a CCR. Patients were divided into two groups: group I (cytoreduction alone) consisted of 22 surgical patients and group II (cytoreduction and HIPEC) consisted of 32 patients. RESULTS There were no significant differences in any of the preoperative variables studied. After a multivariate analysis of factors identified in the univariate analysis, only the presence of tumors with undifferentiated histology (hazard ratio 2.57; 95% CI 1.21-5.46; p < 0.05) was an independent factor associated with a reduced disease-free survival. The 1- and 3-year disease-free survival was 77 and 23% in patients from group I and 77 and 45% in patients from group II, respectively, with a tendency, but no significant differences (p = 0.078). There was no significant difference in postoperative morbidity between the two groups. CONCLUSIONS The administration of HIPEC in patients in whom it is possible to achieve a CCR of the disease has not increased postoperative morbidity and mortality rates in our center. HIPEC with paclitaxel is effective in the treatment of microscopic disease in platinum-sensitive recurrent epithelial ovarian cancer patients with microscopic residual disease after cytoreduction, although with no statistically significant difference.
Collapse
Affiliation(s)
- Pedro Antonio Cascales-Campos
- Unidad De Cirugía De La Carcinomatosis Peritoneal, Departamento De Cirugía General, Virgen De La Arrixaca University Hospital, IMIB Arrixaca, Murcia, Spain,
| | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Cascales-Campos P, Gil J, Gil E, Feliciangeli E, López V, Gonzalez AG, Ruiz-Pardo J, Nieto A, Parrilla P. Cytoreduction and HIPEC after neoadjuvant chemotherapy in stage IIIC-IV ovarian cancer. Critical analysis in elderly patients. Eur J Obstet Gynecol Reprod Biol 2014; 179:88-93. [PMID: 24965986 DOI: 10.1016/j.ejogrb.2014.05.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 05/06/2014] [Accepted: 05/20/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of our study was to evaluate postoperative morbidity and mortality, disease-free and overall survival in patients older than 75 years undergoing interval debulking after neoadjuvant chemotherapy and intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC). STUDY DESIGN Were included a series of consecutive patients diagnosed with stages IIIC/IV ovarian carcinoma, intervened after neoadjuvant systemic chemotherapy (paclitaxel and carboplatin) between January 2008 and June 2013. After completion of cytoreduction HIPEC was administered using paclitaxel (60mg/m(2)) or cisplatin (75mg/m(2)). We analyzed and compared the results of postoperative morbidity and mortality, disease-free survival and overall survival in patients ≥75 years compared to patients with lower ages intervened in the same time period. RESULTS From a total of 66 patients tested, 9 patients were ≥75 years (14%). Grade I-IV morbidity was significantly higher in patients ≥75 years (78% vs 35%, p<0.05) as well as grade III-IV disease (56% vs 16%, p<0.05). There were no procedure-related mortality. In patients ≥75 years the median disease-free survival was 6 months (95% CI: 3.5-8.5 months) vs 24 months (95% CI: 10.5-37.5 months) in younger patients. The median overall survival in patients ≥75 years was 13 months (95% CI: 4.7-21.3), not having reached at time of analysis of the database in younger patients. CONCLUSIONS Patients ≥75 years received no benefit in prognosis after interval cytoreduction with HIPEC and paid a high price in terms of postoperative morbidity. This age group should be excluded from this therapeutic procedure.
Collapse
Affiliation(s)
- P Cascales-Campos
- Department of Surgery, Peritoneal Carcinomatosis Unit, Department of Surgery, Virgen De La Arrixaca University Hospital, Murcia, Spain.
| | - J Gil
- Department of Surgery, Peritoneal Carcinomatosis Unit, Department of Surgery, Virgen De La Arrixaca University Hospital, Murcia, Spain
| | - E Gil
- Department of Surgery, Peritoneal Carcinomatosis Unit, Department of Surgery, Virgen De La Arrixaca University Hospital, Murcia, Spain
| | - E Feliciangeli
- Department of Medical Oncologist, Peritoneal Carcinomatosis Unit, Virgen De La Arrixaca University Hospital, Murcia, Spain
| | - V López
- Department of Surgery, Peritoneal Carcinomatosis Unit, Department of Surgery, Virgen De La Arrixaca University Hospital, Murcia, Spain
| | - A Gil Gonzalez
- Department of Surgery, Peritoneal Carcinomatosis Unit, Department of Surgery, Virgen De La Arrixaca University Hospital, Murcia, Spain
| | - J Ruiz-Pardo
- Department of Surgery, Peritoneal Carcinomatosis Unit, Department of Surgery, Virgen De La Arrixaca University Hospital, Murcia, Spain
| | - A Nieto
- Department of Gynecologic Oncology, Peritoneal Carcinomatosis Unit, Virgen De La Arrixaca University Hospital, Murcia, Spain
| | - P Parrilla
- Department of Surgery, Peritoneal Carcinomatosis Unit, Department of Surgery, Virgen De La Arrixaca University Hospital, Murcia, Spain
| |
Collapse
|
10
|
Cascales-Campos PA, Gil J, Gil E, Feliciangeli E, González-Gil A, Parrilla JJ, Parrilla P. Treatment of microscopic disease with hyperthermic intraoperative intraperitoneal chemotherapy after complete cytoreduction improves disease-free survival in patients with stage IIIC/IV ovarian cancer. Ann Surg Oncol 2014; 21:2383-9. [PMID: 24599409 DOI: 10.1245/s10434-014-3599-4] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND We analyze the efficacy of hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) for microscopic residual disease in patients with stage IIIC/IV ovarian cancer after a complete cytoreduction of their disease. PATIENTS AND METHODS We analyzed the data of 87 consecutive patients diagnosed with stage IIIC/IV ovarian cancer operated between December 1998 and July 2011. In every patient it was possible to achieve a complete cytoreduction of their disease. (Since January 2008, our center has incorporated the use of HIPEC in patients with peritoneal surface malignancies, including patients with peritoneal dissemination of primary ovarian cancer.) RESULTS Of 87 patients, 52 were treated with HIPEC (paclitaxel 60 mg/m(2), 60 min, 42 °C). After a univariate analysis, factors associated with lower disease-free interval were: performing a gastrointestinal anastomosis, operative time greater than 270 min, poorly differentiated histology, and not being treated with HIPEC. After multivariate analysis, independent prognostic factors included not being treated with HIPEC [hazard ratio (HR) 8.77, 95 % CI 2.76-14.42, p < 0.01] and the presence of poorly differentiated tumors (HR 1.98, 95 % CI 1.45-8.56, p < 0.05). Disease-free survival at 1 and 3 years was 66 and 18 %, respectively, in patients without HIPEC and 81 and 63 %, respectively, in patients treated with HIPEC (p < 0.01). HIPEC administration did not alter the results obtained for disease-free survival in patients with undifferentiated tumors. CONCLUSIONS The treatment of the microscopic disease following complete cytoreduction with HIPEC in patients with advanced ovarian cancer is effective and can prolong disease-free survival. This survival benefit was not seen in undifferentiated tumors.
Collapse
Affiliation(s)
- Pedro Antonio Cascales-Campos
- Departamento De Cirugía General, Unidad De Cirugía De La Carcinomatosis Peritoneal, Virgen De La Arrixaca University Hospital, Murcia, Spain,
| | | | | | | | | | | | | |
Collapse
|