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Coquard R, Ayzac L, Romestaing P, Ardiet JM, Sentenac I, Gilly FN, Braillon G, Gérard JP. Adenocarcinoma of the Body and Tail of the Pancreas: Is There Room for Adjuvant Radiotherapy? Tumori 2018; 83:740-2. [PMID: 9349313 DOI: 10.1177/030089169708300405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and background Adenocarcinoma of the body and tail of the pancreas is a rare malignancy with a poor prognosis. Few long-term survivors have been reported in the literature. The role of adjuvant treatment after curative resection has not yet been assessed. This retrospective study aims to describe the patterns of failure and the survival of 10 patients treated with resection and adjuvant radiotherapy. Materials and methods from 1982 to June 1994, 10 patients with adenocarcinoma of the body and tail of the pancreas received adjuvant radiotherapy in our department. There were 4 females and 6 males, with a median age of 63 years (range, 45–77). The pT distribution was 2 pT1, 4 pT2, 4 pT3 and for pN it was 7 pN0 and 3 pN1. Four patients had stage I, 3 stage II and 3 stage III disease. All the patients underwent a resection: distal pancreatectomy in 7, partial resection of the body in 1, and total pancreatectomy in 2. Gross residual disease was present in 2 cases. Three patients received intraoperative radiotherapy up to a dose of 12–15 Gy. Postoperative radiotherapy was given in 9 patients with a dose ranging from 40 to 50 Gy (median, 45). One patient who received intraoperative radiotherapy had no postoperative radiotherapy. In 4 patients, chemotherapy with 5-fluorouracil was given during the first week of irradiation. Results Six patients experienced a local-regional relapse and 3 developed metastases. The median survival was 21 months. The 5-year overall survival was 15%. Eight patients died of progressive disease. One patient who presented with stage I disease was alive and free of disease at 24 months from diagnosis and, interestingly, one with stage III disease was alive at 111 months. No severe treatment-related complications were observed. Conclusions As in carcinoma of the head of the pancreas, adjuvant radiotherapy should be considered as an adjuvant treatment of resected adenocarcinoma of the body and tail of the pancreas. Further evaluation is necessary to assess the role of intraoperative radiotherapy.
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Affiliation(s)
- R Coquard
- Service de Radiothérapie Oncologie, Centre Hospitalier Lyon Sud, Pierre Bénite, France
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2
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Villeneuve L, Passot G, Glehen O, Isaac S, Bibeau F, Rousset P, Gilly FN. The RENAPE observational registry: rationale and framework of the rare peritoneal tumors French patient registry. Orphanet J Rare Dis 2017; 12:37. [PMID: 28212684 PMCID: PMC5316145 DOI: 10.1186/s13023-017-0571-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 01/13/2017] [Indexed: 01/23/2023] Open
Abstract
Background Rare peritoneal cancers represent complex clinical situations requiring a specific and multidisciplinary management. Because of their rarity, lack of awareness and knowledge often leads to diagnostic delays and misdiagnosis. And patients are not systematically referred to expert centers as they should be. Clinicians and researchers also face unique challenges with these rare cancers, because it is hard to conduct adequately powered, controlled trials in such small patient population. This is how an observational patient registry constitutes a key instrument for the development of epidemiological and clinical research in the field of these rare cancers. It is the appropriate tool to pool scarce data for epidemiological research and to assess the impact of diagnostic and therapeutic strategies. We aimed to provide the outlines and the framework of the RENAPE observational registry and share our experience in the establishment of a national patient registry. Results The RENAPE observational registry has been launched in 2010 thanks to institutional supports. It concerns only patients with a histological diagnosis confirming a peritoneal surface malignancy. A web secured clinical database has been implemented based on data management procedures according to the principles of international recommendations and regulatory statements. A virtual tumor bank is linked in order to the conduct translational studies. Specialized working groups have been established to continuously upgrade and evolve the common clinical and histological data elements following the last classifications and clinical practices. They contribute also to standardize clinical assessment and homogenize practices. Conclusions The RENAPE Registry may improve awareness and understanding of the rare peritoneal tumors into the incidence, prevalence, recurrence, survival and mortality rates, as well as treatment practices thereby enabling therapeutic intervention to be evaluated and ultimately optimized. Trial registration ClinicalTrials.gov Identifier: NCT02834169
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Affiliation(s)
- L Villeneuve
- Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Unité de Recherche Clinique, Lyon, France. .,EMR 3738, Lyon 1 University, Lyon, France. .,RENAPE, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite, France.
| | - G Passot
- EMR 3738, Lyon 1 University, Lyon, France.,Department of Digestive Surgery, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - O Glehen
- EMR 3738, Lyon 1 University, Lyon, France.,Department of Digestive Surgery, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - S Isaac
- EMR 3738, Lyon 1 University, Lyon, France.,Department of Pathology, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - F Bibeau
- Department of Pathology, Centre Hospitalier Universitaire, Caen, France
| | - P Rousset
- EMR 3738, Lyon 1 University, Lyon, France.,Department of Radiology, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - F N Gilly
- EMR 3738, Lyon 1 University, Lyon, France.,Department of Digestive Surgery, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
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3
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Kepenekian V, Elias D, Passot G, Mery E, Goere D, Delroeux D, Quenet F, Ferron G, Pezet D, Guilloit JM, Meeus P, Pocard M, Bereder JM, Abboud K, Arvieux C, Brigand C, Marchal F, Classe JM, Lorimier G, De Chaisemartin C, Guyon F, Mariani P, Ortega-Deballon P, Isaac S, Maurice C, Gilly FN, Glehen O. Diffuse malignant peritoneal mesothelioma: Evaluation of systemic chemotherapy with comprehensive treatment through the RENAPE Database: Multi-Institutional Retrospective Study. Eur J Cancer 2016; 65:69-79. [PMID: 27472649 DOI: 10.1016/j.ejca.2016.06.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 05/26/2016] [Accepted: 06/01/2016] [Indexed: 12/12/2022]
Abstract
PURPOSE Diffuse malignant peritoneal mesothelioma (DMPM) is a severe disease with mainly locoregional evolution. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is the reported treatment with the longest survival. The aim of this study was to evaluate the impact of perioperative systemic chemotherapy strategies on survival and postoperative outcomes in patients with DMPM treated with curative intent with CRS-HIPEC, using a multi-institutional database: the French RENAPE network. PATIENTS AND METHODS From 1991 to 2014, 126 DMPM patients underwent CRS-HIPEC at 20 tertiary centres. The population was divided into four groups according to perioperative treatment: only neoadjuvant chemotherapy (NA), only adjuvant chemotherapy (ADJ), perioperative chemotherapy (PO) and no chemotherapy before or after CRS-HIPEC (NoC). RESULTS All groups (NA: n = 42; ADJ: n = 16; PO: n = 16; NoC: n = 48) were comparable regarding clinicopathological data and main DMPM prognostic factors. After a median follow-up of 61 months, the 5-year overall survival (OS) was 40%, 67%, 62% and 56% in NA, ADJ, PO and NoC groups, respectively (P = 0.049). Major complications occurred for 41%, 45%, 35% and 41% of patients from NA, ADJ, PO and NoC groups, respectively (P = 0.299). In multivariate analysis, NA was independently associated with worse OS (hazard ratio, 2.30; 95% confidence interval, 1.07-4.94; P = 0.033). CONCLUSION This retrospective study suggests that adjuvant chemotherapy may delay recurrence and improve survival and that NA may impact negatively the survival for patients with DMPM who underwent CRS-HIPEC with curative intent. Upfront CRS and HIPEC should be considered when achievable, waiting for stronger level of scientific evidence.
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Affiliation(s)
- V Kepenekian
- Department of Digestive Surgery, Lyon-Sud University Hospital, EMR 3738, Lyon 1 University, Lyon, France
| | - D Elias
- Department of Surgical Oncology, Gustave Roussy, Cancer Campus, Grand Paris, France
| | - G Passot
- Department of Digestive Surgery, Lyon-Sud University Hospital, EMR 3738, Lyon 1 University, Lyon, France
| | - E Mery
- Department of Pathology, IUCT, Toulouse, France
| | - D Goere
- Department of Surgical Oncology, Gustave Roussy, Cancer Campus, Grand Paris, France
| | - D Delroeux
- Department of Digestive Surgery, Jean Minjoz University Hospital, Besançon, France
| | - F Quenet
- Department of Surgical Oncology, Val d'Aurelle Montpellier Cancer Institute, Montpellier, France
| | - G Ferron
- Department of Surgical Oncology, Claudius Regaud Institute - IUCT, Toulouse, France
| | - D Pezet
- Department of Digestive Surgery, Estaing University Hospital, Clermont-Ferrand, France
| | - J M Guilloit
- Department of Surgical Oncology, Francois Baclesse Comprehensive Cancer Center, Caen, France
| | - P Meeus
- Department of Surgery, Léon Bérard Comprehensive Cancer Center, Lyon, France
| | - M Pocard
- Surgical Oncologic & Digestive Unit, Lariboisière University Hospital, INSERM, U 965, Paris, France
| | - J M Bereder
- Department of General Surgery and Gastrointestinal Oncology, Archet 2 University Hospital, Nice, France
| | - K Abboud
- Department of Digestive Surgery, University Hospital of Saint Etienne, Saint Etienne, France
| | - C Arvieux
- Department of Digestive Surgery, Michallon University Hospital, Grenoble, France
| | - C Brigand
- Department of General Surgery, Hautepierre University Hospital, Strasbourg, France
| | - F Marchal
- Department of Surgical Oncology, Lorraine Institute of Oncology, Vandoeuvre-les-Nancy, France
| | - J M Classe
- Department of Surgical Oncology, René Gauducheau Integrated Center of Oncology, Nantes, France
| | - G Lorimier
- Department of Surgical Oncology, Paul Papin Integrated Center of Oncology, Angers, France
| | - C De Chaisemartin
- Department of Surgical Oncology, Paoli-Calmettes Institute, Marseille, France
| | - F Guyon
- Department of Surgical Oncology, Bergonie Institute, Bordeaux, France
| | - P Mariani
- Department of Surgical Oncology, Curie Institute, Paris, France
| | - P Ortega-Deballon
- Department of Digestive Surgical Oncology, University Hospital of Dijon, Dijon, France
| | - S Isaac
- Department of Pathology, Lyon-Sud University Hospital, Lyon, France
| | - C Maurice
- Clinical Research Unit, Pôle IMER (Information Médicale Evaluation et Recherche), Hospices Civils de Lyon, Lyon, France
| | - F N Gilly
- Department of Digestive Surgery, Lyon-Sud University Hospital, EMR 3738, Lyon 1 University, Lyon, France
| | - O Glehen
- Department of Digestive Surgery, Lyon-Sud University Hospital, EMR 3738, Lyon 1 University, Lyon, France.
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Hommell-Fontaine J, Isaac S, Passot G, Decullier E, Traverse-Glehen A, Cotte E, You B, Mohamed F, Gilly FN, Glehen O, Berger F. Erratum to: Malignant Peritoneal Mesothelioma Treated by Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Is GLUT1 Expression a Major Prognostic Factor? A Preliminary Study. Ann Surg Oncol 2014. [DOI: 10.1245/s10434-013-3389-4] [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: 11/18/2022]
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Kusamura S, Moran BJ, Sugarbaker PH, Levine EA, Elias D, Baratti D, Morris DL, Sardi A, Glehen O, Deraco M, Gilly FN, Barrios P, Quenet F, Loggie BW, Gómez Portilla A, de Hingh IHJT, Ceelen WP, Pelz JOW, Piso P, González-Moreno S, Van Der Speeten K, Chua TC, Yan TD, Liauw W. Multicentre study of the learning curve and surgical performance of cytoreductive surgery with intraperitoneal chemotherapy for pseudomyxoma peritonei. Br J Surg 2014; 101:1758-65. [DOI: 10.1002/bjs.9674] [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: 01/05/2014] [Revised: 08/19/2014] [Accepted: 09/17/2014] [Indexed: 12/18/2022]
Abstract
Abstract
Background
The learning curves for cytoreductive surgery with intraperitoneal chemotherapy for treatment of pseudomyxoma peritonei (PMP) were explored between international centres/surgeons to identify institutional or other factors that might affect performance.
Methods
Data from patients with PMP treated with the combined procedure across 33 international centres between 1993 and 2012 were analysed retrospectively. A risk-adjusted sequential probability ratio test was conducted after defining the target outcome as early oncological failure (disease progression within 2 years of treatment), an acceptable risk for the target outcome (odds ratio) of 2, and type I/II error rates of 5 per cent. The risk prediction model was elaborated and patients were evaluated sequentially for each centre/surgeon. The learning curve was considered to be overcome and proficiency achieved when the odds ratio for early oncological failure became smaller than 2.
Results
Rates of optimal cytoreduction, severe postoperative morbidity and early oncological failure were 84·4, 25·7 and 29·0 per cent respectively. The median annual centre volume was 17 (range 6–66) peritoneal malignancies. Only eight of the 33 centres and six of 47 surgeons achieved proficiency after a median of 100 (range 78–284) and 96 (86–284) procedures respectively. The most important institutional factor affecting surgical performance was centre volume.
Conclusion
The learning curve is extremely long, so centralization and/or networking of centres is necessary to assure quality of services. One centre for every 10–15 million inhabitants would be ideal.
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Affiliation(s)
- S Kusamura
- Peritoneal Surface Malignancy Programme, Colorectal Cancer Unit, IRCCS Fondazione Istituto Nazionale Tumori di Milano, Milan, Italy
| | - B J Moran
- Basingstoke and North Hampshire NHS Foundation Trust, Basingstoke, UK
| | - P H Sugarbaker
- Washington Cancer Institute, Washington Hospital Center, Washington, DC
| | - E A Levine
- Surgical Oncology Service, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina
| | - D Elias
- Department of Surgical Oncology, Institut Gustave Roussy, Cancer Centre, Villejuif
- RENAPE: Centre Expert National de Référence des Cancers Rares du Péritoine, Unité de Recherche Clinique, Centre Hospitalier Universitaire (CHU) de Lyon Sud, Pierre Bénite, France
| | - D Baratti
- Peritoneal Surface Malignancy Programme, Colorectal Cancer Unit, IRCCS Fondazione Istituto Nazionale Tumori di Milano, Milan, Italy
| | - D L Morris
- Hepatobiliary and Surgical Oncology Unit, University of New South Wales Department of Surgery, St George Hospital, New South Wales, Sydney, Australia
| | - A Sardi
- Division of Surgery, Department of Surgical Oncology, Institute for Cancer Care, Mercy Medical Center, Baltimore, Maryland, USA
| | - O Glehen
- RENAPE: Centre Expert National de Référence des Cancers Rares du Péritoine, Unité de Recherche Clinique, Centre Hospitalier Universitaire (CHU) de Lyon Sud, Pierre Bénite, France
- Department of Digestive Surgery, CHU de Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - M Deraco
- Peritoneal Surface Malignancy Programme, Colorectal Cancer Unit, IRCCS Fondazione Istituto Nazionale Tumori di Milano, Milan, Italy
| | - F N Gilly
- Department of Digestive Surgery, Centre Hospitalier Universitaire (CHU) de Lyon Sud, Hospices Civils de Lyon, and RENAPE, Unité de Recherche Clinique, CHU de Lyon Sud, Pierre-Benite, France
| | - P Barrios
- Department of Oncological Surgery, Hospital Sant Joan Despí, Moises Broggi, Peritoneal Surface Malignancy Catalonian's Programme, Sant Joan Despí, Barcelona, Spain
| | - F Quenet
- Centre Régional de Lutte du Cancer Val d'Aurell, Montpellier, and RENAPE, CHU de Lyon Sud, Pierre-Benite, France
| | - B W Loggie
- Division of Surgical Oncology, Creighton University Medical Center, Omaha, New England, USA
| | - A Gómez Portilla
- Department of General Surgery and Digestive Diseases, Hospital Santiago Apostol, Vitoria, Spain
| | - I H J T de Hingh
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - W P Ceelen
- Department of Gastrointestinal Surgery, University Hospital, Ghent, Belgium
| | - J O W Pelz
- Department of General, Visceral and Paediatric Surgery, University of Wuerzburg, Wuerzburg, Germany
| | - P Piso
- Department of Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - S González-Moreno
- Peritoneal Surface Oncology Programme, Department of Surgical Oncology, M. D. Anderson Cancer Center Madrid, Madrid, Spain
| | - K Van Der Speeten
- Department of Surgical Oncology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - T C Chua
- Hepatobiliary and Surgical Oncology Unit, University of New South Wales Department of Surgery, St George Hospital, Sydney, New South Wales, Australia
| | - T D Yan
- Department of Cardiothoracic Surgery, University of Sydney, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - W Liauw
- Hepatobiliary and Surgical Oncology Unit, University of New South Wales Department of Surgery, St George Hospital, Sydney, New South Wales, Australia
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Passot G, Bakrin N, Isaac S, Decullier E, Gilly FN, Glehen O, Cotte E. Postoperative outcomes of laparoscopic vs open cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy for treatment of peritoneal surface malignancies. Eur J Surg Oncol 2013; 40:957-62. [PMID: 24209429 DOI: 10.1016/j.ejso.2013.10.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 09/16/2013] [Accepted: 10/02/2013] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are considered the only curative treatment for many peritoneal surface malignancies. The purpose of this study was to evaluate feasibility and safety of CRS combined with HIPEC by laparoscopy for patients with limited peritoneal disease and to compare postoperative outcomes with those for an open procedure. METHODS Between January 2011 and November 2012, all patients with low-grade pseudomyxoma peritonei (PMP) or multicystic mesothelioma (MM) and limited peritoneal disease (Peritoneal Cancer Index [PCI] less than 10) underwent CRS and HIPEC by a laparoscopic approach. The study cohort was matched with a historical cohort of patients with the same characteristics (completeness of cytoreduction, HIPEC agent, PCI ± 11 and age ± 20 years) treated with CRS and HIPEC by laparotomy. RESULTS Eight patients (five low-grade PMP and three MM) treated by a laparoscopic approach were compared to eight patients treated by laparotomy. All patients underwent complete cytoreductive surgery with HIPEC, and no conversion to laparotomy was needed. The median surgical length was 210 min (150-300) vs 240 (210-360), with a median hospital stay of 12 days (9-18) vs 19 (13-33). One patient had a postoperative complication (intraperitoneal haematoma treated by radiological drainage) vs four in the laparotomy group. CONCLUSION Laparoscopic CRS combined with HIPEC is feasible and safe for curative treatment of strictly selected patients with peritoneal surface malignancy and might reduce postoperative complications and length of hospital stay.
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Affiliation(s)
- G Passot
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud Pierre Bénite, Department of Oncologic and General Surgery, France; UMR 37-38 Université Lyon 1, Lyon, France
| | - N Bakrin
- UMR 37-38 Université Lyon 1, Lyon, France; Hospices Civils de Lyon, Centre Hospitalier Lyon Sud Pierre Bénite, Gynecology Department, France
| | - S Isaac
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud Pierre Bénite, Department of Pathology, France
| | - E Decullier
- Hospices Civils de Lyon, Pole IMER, Lyon, France; Health Information and Clinical Research, France
| | - F N Gilly
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud Pierre Bénite, Department of Oncologic and General Surgery, France; UMR 37-38 Université Lyon 1, Lyon, France
| | - O Glehen
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud Pierre Bénite, Department of Oncologic and General Surgery, France; UMR 37-38 Université Lyon 1, Lyon, France.
| | - E Cotte
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud Pierre Bénite, Department of Oncologic and General Surgery, France; UMR 37-38 Université Lyon 1, Lyon, France
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7
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Hommell-Fontaine J, Isaac S, Passot G, Decullier E, Traverse-Glehen A, Cotte E, You B, Mohamed F, Gilly FN, Glehen O, Berger F. Malignant peritoneal mesothelioma treated by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: is GLUT1 expression a major prognostic factor? A preliminary study. Ann Surg Oncol 2013; 20:3892-8. [PMID: 23800898 DOI: 10.1245/s10434-013-3077-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Indexed: 01/14/2023]
Abstract
PURPOSE Diffuse malignant peritoneal mesothelioma (DMPM) is a rare primary peritoneal malignancy. Its prognosis has been improved by an aggressive locoregional treatment combining extensive cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Prognostic factors are currently poorly defined for this disease but are essential if treatment is to be standardized. METHODS Twenty-eight patients with DMPM, who were considered preoperatively to be candidates for CRS and HIPEC between June 1998 and August 2010 at our institution, were selected for this study. Medical records and histopathological features were retrospectively reviewed and 24 clinical, histological, and immunohistochemical parameters were assessed for their association with overall survival by univariate and multivariate analyses. RESULTS The following factors were significantly associated with overall survival by univariate analysis: predominant histological growth pattern in the epithelioid areas, nuclear grooves in the epithelioid areas, atypical mitoses, and calretinin and GLUT1 expression by immunohistochemistry in the epithelioid areas. Expression of the facilitative glucose transporter protein GLUT1 in the epithelioid areas was the only factor independently associated with overall survival by multivariate analysis. CONCLUSIONS GLUT1 expression appears to be an indicator of poor prognosis in DMPM. Standard histological classification of DMPM may not be adequate to select patients for aggressive locoregional treatments, such as CRS and HIPEC. Multicenter validation of the prognostic factors identified in this preliminary study is needed to refine patient selection for potential cure.
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Affiliation(s)
- J Hommell-Fontaine
- Service de Chirurgie Générale, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
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8
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Bakrin N, Gilly FN, Baratti D, Bereder JM, Quenet F, Lorimier G, Mohamed F, Elias D, Glehen O. Primary peritoneal serous carcinoma treated by cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy. A multi-institutional study of 36 patients. Eur J Surg Oncol 2013; 39:742-7. [PMID: 23510853 DOI: 10.1016/j.ejso.2013.02.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 02/12/2013] [Accepted: 02/20/2013] [Indexed: 12/22/2022] Open
Abstract
AIM Primary peritoneal serous carcinoma (PPSC) is a rare condition, histologically identical to ovarian serous carcinoma and often diagnosed at late stage. There is not any standardized treatment for PPSC. A retrospective multicentric study was performed in French speaking centers to evaluate cytoreduction surgery and Hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment of peritoneal carcinomatosis from different origins. The manuscript's aim was to study the particular population with PPSC. METHODS Between September 1997 and July 2007, 36 patients with PPSC from 9 institutions underwent 39 procedures. RESULTS Mortality and morbidity rates were 5.6% and 20.6% respectively. The overall survival at 1, 3 and 5 years are respectively 93.6, 71.5 and 57.4%. The median overall survival was not reached. By univariate analysis, the only factor that had prognostic value was PCI (p = 0.03). CONCLUSIONS The therapeutic approach combining cytoreductive surgery with HIPEC may achieve long-term survival in patients with PPSC.
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Affiliation(s)
- N Bakrin
- Surgical Oncology Department, Lyon Civil Hospices, South Lyon University Hospital Center, 165 chemin du grand Revoyet, 69365 Pierre Bénite, France.
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9
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Bakrin N, Cotte E, Golfier F, Gilly FN, Freyer G, Helm W, Glehen O, Bereder JM. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) for persistent and recurrent advanced ovarian carcinoma: a multicenter, prospective study of 246 patients. Ann Surg Oncol 2012; 19:4052-8. [PMID: 22825772 DOI: 10.1245/s10434-012-2510-4] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Indexed: 12/22/2022]
Abstract
BACKGROUND Epithelial ovarian carcinoma is the main cause of death from gynaecological cancers in the western world. The initial response rate to the frontline therapy is high. However, the prognosis of persistent and recurrent disease remains poor. During the two past decades, a new therapeutic approach to peritoneal carcinomatosis has been developed, combining maximal cytoreductive effort with hyperthermic intraperitoneal chemotherapy (HIPEC). METHODS A retrospective, multicentric study of 246 patients with recurrent or persistent ovarian cancer, treated by cytoreductive surgery and HIPEC in two French centers between 1991 and 2008, was performed. RESULTS An optimal cytoreductive surgery was possible in 92.2 % of patients. Mortality and morbidity rates were 0.37 % and 11.6 %, respectively. The overall median survival was 48.9 months. There was no significant difference in overall survival in patients with persistent or recurrent disease. In multivariate analysis, performance status was a significant prognostic factor in patients with extensive peritoneal carcinomatosis (peritoneal cancer index >10). CONCLUSIONS Salvage therapy combining optimal cytoreductive surgery and HIPEC is feasible and may achieve long-term survival in highly selected patients with recurrent ovarian carcinoma, including those with platinum resistant disease, with acceptable morbidity.
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Affiliation(s)
- N Bakrin
- Department of Oncologic Surgery, Centre Hospitalier Lyon Sud, Pierre-Bénite, France.
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10
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Piaton E, Villeneuve L, Maurice C, Paulin C, Cottier M, Fontanière B, Salle M, Seigneurin D, Vancina S, Decullier E, Gilly FN, Cotte E. Intraperitoneal free cancer cells in non-gynaecological adenocarcinomas: a reproducibility study. Cytopathology 2011; 23:242-9. [PMID: 21736645 DOI: 10.1111/j.1365-2303.2011.00889.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE In recent years, therapeutic approaches including cytoreductive surgery followed by intraperitoneal chemotherapy have proven effective in peritoneal carcinomatosis of colorectal origin. If cytology is to be used to include patients in aggressive treatment regimens, it is necessary to evaluate its performance, particularly in terms of specificity. The aim of this study was to assess interobserver agreement for the detection of intraperitoneal free cancer cells (IFCCs) in patients with non-gynaecological adenocarcinomas. METHODS Over a 5-year period, 1223 patients were recruited in 19 French surgery departments. Peritoneal samples were examined in 14 dispersed pathology laboratories. Giemsa-stained slides were sent to a control reader blind to the previous diagnosis. Discordant cases, concordant positive results and a random selection of negative concordant cases were reviewed by a panel of seven cytopathologists. The 'final diagnosis' was that of the consensus meetings but took into account locally-processed slides. RESULTS Gathering dubious cases with negative results, a 95.6% concordance was achieved between local readers and the control reader. IFCCs were ascertained by the panel in 85 cases (7.0%). Eight of 873 colorectal cancers cases viewed locally were falsely positive (0.9%). Radiotherapy and neoadjuvant therapy had no impact on the false-positive rate as assessed by final validation by the panel (P > 0.05). Samples initially considered as dubious were reclassified as negative by the panel in 24 of 25 cases (96.0%). CONCLUSIONS The panel consensus allowed reclassification of most dubious/equivocal peritoneal cytology cases, whereas clearcut distinction between benign and malignant cases was correctly achieved in almost all cases.
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Affiliation(s)
- E Piaton
- Hospices Civils de Lyon, Centre de Pathologie Est, Bron Université Lyon 1, Lyon, France.
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Passot G, Glehen O, Pellet O, Isaac S, Tychyj C, Mohamed F, Giammarile F, Gilly FN, Cotte E. Pseudomyxoma peritonei: role of 18F-FDG PET in preoperative evaluation of pathological grade and potential for complete cytoreduction. Eur J Surg Oncol 2009; 36:315-23. [PMID: 19818580 DOI: 10.1016/j.ejso.2009.09.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Revised: 09/03/2009] [Accepted: 09/10/2009] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION For pseudomyxoma peritonei (PMP), survival depends on pathological grade and completeness of cytoreductive surgery. The aim of the study was to assess the ability of preoperative 18F-FDG PET to determine these 2 prognosis indicators. MATERIAL AND METHODS In this prospective single centre study, all patients presenting with PMP were included. They underwent a preoperative 18F-FDG PET with a double radiological evaluation and an explorative laparotomy with the objective of optimal cytoreduction followed by a hyperthermic intra-operative intraperitoneal chemotherapy (HIPEC). Patients with non resectable disease underwent debulking surgery without HIPEC. The Completeness of Cytoreduction was assessed by CC score. RESULTS Thirty-four patients were included. PET scanning was positive for 19 patients with grade II (hybrid form) or III (Peritoneal Mucinous Carcinomatosis) and for 2 patients with grade I (disseminated peritoneal adenomucinosis), and negative for 3 patients with grade II - III and for 10 patients with grade I. PET scanning was positive for 6 patients with CC score 2 - 3 and for 16 patients with CC score 0, and negative for 2 patients with CC score 2 - 3 and for 10 patients with CC score 0. The 18F-FDG PET interpretation distinguished 2 patients groups (grade I and grade II - III) with a sensitivity of 90% and a specificity of 77%. Moreover, probability of complete cytoreduction when PET was negative was over 80%. CONCLUSION Preoperative 18F-FDG PET may predict pathological grade and completeness of cytoreduction which are the two main prognostic factors in patients with PMP.
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Affiliation(s)
- G Passot
- Department of oncologic surgery, Centre Hospitalier Lyon Sud, Pierre Bénite, France
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12
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Glehen O, Elias D, Gilly FN, Boutitie F, Bereder JM, Quenet F, Sideris L, Mansvelt B, Lorimier G. Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from digestive or primitive origin: A multi-institutional study of 1,290 patients. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.4102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4102 Background: Peritoneal carcinomatosis (PC) from non-gynecologic malignancies has long been regarded a terminal disease with a short median survival. Over the past decade, new locoregional therapeutic approaches combining cytoreductive surgery with perioperative intraperitoneal chemotherapy (PIC) have evolved and suggest improved survival. Methods: A retrospective multicentric study was performed in French speaking centers to evaluate the toxicity and the principal prognostic factors in order to identify the best indications. All patients had cytoreductive surgery and PIC (hyperthermic intraperitoneal chemotherapy (HIPEC) and or early postoperative intraperitoneal chemotherapy (EPIC)). Results: The study included 1290 patients from 25 institutions between February 1989 and December 2007. The principal etiologies of PC were colorectal adenocarcinoma (N=523), pseudomyxoma peritonei (N=301), gastric adenocarcinoma (N=159), peritoneal mesothelioma (N=88), and appendiceal adenocarcinoma (N=50). Mortality and morbidity rates were 4.1% and 33.8%, respectively. By multivariate analysis, age, extent of the PC, and the institution's experience had a significant influence on toxicity. The overall median survival was 34 months: 30 months for colorectal PC, not reached for pseudomyxoma peritonei, 9 months for gastric PC, 41 months for peritoneal mesothelioma, and 77 months for PC from appendiceal adenocarcinoma. Independent prognostic indicators by multivariate analysis were the institution's experience, etiology, completeness of cytoreductive surgery, extent of carcinomatosis, and lymph node involvement. Conclusions: The therapeutic approach combining cytoreductive surgery with PIC may achieve long-term survival in a selected group of patients with PC from non-gynecologic origin with acceptable mortality and morbidity. This treatment should be reserved to experienced institutions involved in the management of PC. No significant financial relationships to disclose.
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Affiliation(s)
- O. Glehen
- Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Institut Gustave Roussy, Villejuif, France; Centre Hospitalier Universitaire Archet II, Nice, France; Centre Val d’Aurelle, Montpellier, France; Hopital Maisonneuve Rosemont, Montréal, QC, Canada; Hopital de Jolimont, Maine St Paul, Belgium; Centre Paul Papin, Angers, France
| | - D. Elias
- Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Institut Gustave Roussy, Villejuif, France; Centre Hospitalier Universitaire Archet II, Nice, France; Centre Val d’Aurelle, Montpellier, France; Hopital Maisonneuve Rosemont, Montréal, QC, Canada; Hopital de Jolimont, Maine St Paul, Belgium; Centre Paul Papin, Angers, France
| | - F. N. Gilly
- Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Institut Gustave Roussy, Villejuif, France; Centre Hospitalier Universitaire Archet II, Nice, France; Centre Val d’Aurelle, Montpellier, France; Hopital Maisonneuve Rosemont, Montréal, QC, Canada; Hopital de Jolimont, Maine St Paul, Belgium; Centre Paul Papin, Angers, France
| | - F. Boutitie
- Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Institut Gustave Roussy, Villejuif, France; Centre Hospitalier Universitaire Archet II, Nice, France; Centre Val d’Aurelle, Montpellier, France; Hopital Maisonneuve Rosemont, Montréal, QC, Canada; Hopital de Jolimont, Maine St Paul, Belgium; Centre Paul Papin, Angers, France
| | - J. M. Bereder
- Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Institut Gustave Roussy, Villejuif, France; Centre Hospitalier Universitaire Archet II, Nice, France; Centre Val d’Aurelle, Montpellier, France; Hopital Maisonneuve Rosemont, Montréal, QC, Canada; Hopital de Jolimont, Maine St Paul, Belgium; Centre Paul Papin, Angers, France
| | - F. Quenet
- Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Institut Gustave Roussy, Villejuif, France; Centre Hospitalier Universitaire Archet II, Nice, France; Centre Val d’Aurelle, Montpellier, France; Hopital Maisonneuve Rosemont, Montréal, QC, Canada; Hopital de Jolimont, Maine St Paul, Belgium; Centre Paul Papin, Angers, France
| | - L. Sideris
- Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Institut Gustave Roussy, Villejuif, France; Centre Hospitalier Universitaire Archet II, Nice, France; Centre Val d’Aurelle, Montpellier, France; Hopital Maisonneuve Rosemont, Montréal, QC, Canada; Hopital de Jolimont, Maine St Paul, Belgium; Centre Paul Papin, Angers, France
| | - B. Mansvelt
- Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Institut Gustave Roussy, Villejuif, France; Centre Hospitalier Universitaire Archet II, Nice, France; Centre Val d’Aurelle, Montpellier, France; Hopital Maisonneuve Rosemont, Montréal, QC, Canada; Hopital de Jolimont, Maine St Paul, Belgium; Centre Paul Papin, Angers, France
| | - G. Lorimier
- Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Institut Gustave Roussy, Villejuif, France; Centre Hospitalier Universitaire Archet II, Nice, France; Centre Val d’Aurelle, Montpellier, France; Hopital Maisonneuve Rosemont, Montréal, QC, Canada; Hopital de Jolimont, Maine St Paul, Belgium; Centre Paul Papin, Angers, France
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Lifante JC, Glehen O, Cotte E, Beaujard AC, Gilly FN. Natural history of peritoneal carcinomatosis from digestive origin. Cancer Treat Res 2007; 134:119-29. [PMID: 17633050 DOI: 10.1007/978-0-387-48993-3_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- J C Lifante
- Lyon 1 University, Surgical Department, Centre Hopitalo-Universitaire Lyon Sud, Pierre Bénite Cedex, France
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Esquivel J, Sticca R, Sugarbaker P, Levine E, Yan TD, Alexander R, Baratti D, Bartlett D, Barone R, Barrios P, Bieligk S, Bretcha-Boix P, Chang CK, Chu F, Chu Q, Daniel S, de Bree E, Deraco M, Dominguez-Parra L, Elias D, Flynn R, Foster J, Garofalo A, Gilly FN, Glehen O, Gomez-Portilla A, Gonzalez-Bayon L, Gonzalez-Moreno S, Goodman M, Gushchin V, Hanna N, Hartmann J, Harrison L, Hoefer R, Kane J, Kecmanovic D, Kelley S, Kuhn J, Lamont J, Lange J, Li B, Loggie B, Mahteme H, Mann G, Martin R, Misih RA, Moran B, Morris D, Onate-Ocana L, Petrelli N, Philippe G, Pingpank J, Pitroff A, Piso P, Quinones M, Riley L, Rutstein L, Saha S, Alrawi S, Sardi A, Schneebaum S, Shen P, Shibata D, Spellman J, Stojadinovic A, Stewart J, Torres-Melero J, Tuttle T, Verwaal V, Villar J, Wilkinson N, Younan R, Zeh H, Zoetmulder F, Sebbag G. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of peritoneal surface malignancies of colonic origin: a consensus statement. Society of Surgical Oncology. Ann Surg Oncol 2006. [PMID: 17072675 DOI: 10.1245/s10434-007-9599-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Esquivel J, Sticca R, Sugarbaker P, Levine E, Yan TD, Alexander R, Baratti D, Bartlett D, Barone R, Barrios P, Bieligk S, Bretcha-Boix P, Chang CK, Chu F, Chu Q, Daniel S, de Bree E, Deraco M, Dominguez-Parra L, Elias D, Flynn R, Foster J, Garofalo A, Gilly FN, Glehen O, Gomez-Portilla A, Gonzalez-Bayon L, Gonzalez-Moreno S, Goodman M, Gushchin V, Hanna N, Hartmann J, Harrison L, Hoefer R, Kane J, Kecmanovic D, Kelley S, Kuhn J, Lamont J, Lange J, Li B, Loggie B, Mahteme H, Mann G, Martin R, Misih RA, Moran B, Morris D, Onate-Ocana L, Petrelli N, Philippe G, Pingpank J, Pitroff A, Piso P, Quinones M, Riley L, Rutstein L, Saha S, Alrawi S, Sardi A, Schneebaum S, Shen P, Shibata D, Spellman J, Stojadinovic A, Stewart J, Torres-Melero J, Tuttle T, Verwaal V, Villar J, Wilkinson N, Younan R, Zeh H, Zoetmulder F, Sebbag G. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of peritoneal surface malignancies of colonic origin: a consensus statement. Society of Surgical Oncology. Ann Surg Oncol 2006; 14:128-33. [PMID: 17072675 DOI: 10.1245/s10434-006-9185-7] [Citation(s) in RCA: 294] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2006] [Revised: 06/02/2006] [Accepted: 06/02/2006] [Indexed: 12/11/2022]
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Milano G, Francoual M, Bourgeon A, Benchimol D, Chazal M, Laurent-Puig P, André T, Letoublon C, Gilly FN, Etienne-Grimaldi MC. Multifactorial prospective study of tumoral factors related to disease-free survival (DFS) in colorectal cancer patients. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.3604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3604 Background: There is still a need to identify faithful biological prognostic factors in colorectal cancer, particularly in stage 2, so as to decide upon adjuvant treatment. We thus conducted a prospective multicentric multifactorial study to this end. Methods: Primary colorectal tumors (30 stage 1, 119 stage 2, 107 stage 3) were prospectively collected in 256 patients undergoing total tumor resection (152 men, 104 women ; mean age 69, extremes 29–90). Adjuvant 5FU-based chemotherapy was administered in 92 patients. Median follow-up was 54 months (53 patients developed metastasis or recurrence). Tumors were analyzed for thymidylate synthase (TS), thymidine phosphorylase and dihydropyrimidine dehydrogenase expression (RT-PCR), TS activity (radioenzymatic assay), EGFR level (ligand-binding assay), VEGF (Elisa), DNA content and cell cycle (flow cytometry), p53 mutations (exon 4 to 8), microsatellite instability (bat 25, bat 26), EGFR genotype (CA repeats in intron 1 and -216G>T), TS genotype in 3’ (6 bp deletion) and 5’ (28 bp repeats including the G>C mutation), and methylenetetrahydrofolate reductase genotype (677C>T and 1298A>C). Results: With the exception of tumor TS expression (p = 0.034, the higher the expression, the better the DFS), none of the analyzed parameters were linked to DFS. In multivariate Cox analysis, tumor staging (p = 0.001) and TS expression (p = 0.062) were the sole factors associated to DFS. Focus on tumoral EGFR revealed large inter-patient variability (from 1 to 510 fmol/mg prot) with a significant influence of tumor localisation (p = 0.009, higher in proximal colon) and differentiation status (p = 0.01, higher in poorly differentiated tumors). EGFR within the tumors was 30 % lower than in adjacent normal mucosa (p<0.001). The longer the intron 1 CA repeats, the higher the tumor EGFR (p = 0.044). EGFR -216G>T polymorphism was linked to intron 1 polymorphism, although -216G>T did not influence EGFR levels. Conclusions: The present results underline the major impact of TS expression as a prognostic factor and provide new insights in the knowledge of EGFR in colorectal cancer. No significant financial relationships to disclose.
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Affiliation(s)
- G. Milano
- Centre Antoine Lacassagne, Nice, France; CHU, Nice, France; INSERM U490, Paris, France; Hôpital Tenon, Paris, France; CHU, Grenoble, France; CHU, Lyon, France
| | - M. Francoual
- Centre Antoine Lacassagne, Nice, France; CHU, Nice, France; INSERM U490, Paris, France; Hôpital Tenon, Paris, France; CHU, Grenoble, France; CHU, Lyon, France
| | - A. Bourgeon
- Centre Antoine Lacassagne, Nice, France; CHU, Nice, France; INSERM U490, Paris, France; Hôpital Tenon, Paris, France; CHU, Grenoble, France; CHU, Lyon, France
| | - D. Benchimol
- Centre Antoine Lacassagne, Nice, France; CHU, Nice, France; INSERM U490, Paris, France; Hôpital Tenon, Paris, France; CHU, Grenoble, France; CHU, Lyon, France
| | - M. Chazal
- Centre Antoine Lacassagne, Nice, France; CHU, Nice, France; INSERM U490, Paris, France; Hôpital Tenon, Paris, France; CHU, Grenoble, France; CHU, Lyon, France
| | - P. Laurent-Puig
- Centre Antoine Lacassagne, Nice, France; CHU, Nice, France; INSERM U490, Paris, France; Hôpital Tenon, Paris, France; CHU, Grenoble, France; CHU, Lyon, France
| | - T. André
- Centre Antoine Lacassagne, Nice, France; CHU, Nice, France; INSERM U490, Paris, France; Hôpital Tenon, Paris, France; CHU, Grenoble, France; CHU, Lyon, France
| | - C. Letoublon
- Centre Antoine Lacassagne, Nice, France; CHU, Nice, France; INSERM U490, Paris, France; Hôpital Tenon, Paris, France; CHU, Grenoble, France; CHU, Lyon, France
| | - F. N. Gilly
- Centre Antoine Lacassagne, Nice, France; CHU, Nice, France; INSERM U490, Paris, France; Hôpital Tenon, Paris, France; CHU, Grenoble, France; CHU, Lyon, France
| | - M. C. Etienne-Grimaldi
- Centre Antoine Lacassagne, Nice, France; CHU, Nice, France; INSERM U490, Paris, France; Hôpital Tenon, Paris, France; CHU, Grenoble, France; CHU, Lyon, France
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Abstract
Peritoneal carcinomatosis (PC) is a common manifestation of colorectal cancer and has traditionally been regarded as a terminal disease with a short median survival. Over the last decade, a new local-regional therapeutic approach combining cytoreductive surgery with perioperative intraperitoneal chemotherapy has evolved and promising survival results were reported in large phase II studies. A retrospective multicentric study of 506 patients from 28 institutions was performed to evaluate the international experience with this combined treatment and to identify the principal prognostic indicators. All patients had cytoreductive surgery and perioperative intraperitoneal chemotherapy (intraperitoneal chemohyperthermia and/or immediate postoperative intraperitoneal chemotherapy) within the 7 days following surgery. The morbidity and mortality rates were 22.9% and 4%, respectively. Patients in whom cytoreductive surgery was complete had a median survival of 32.4 months compared to 8.4 months for patients in whom complete cytoreductive surgery was not possible (p < 0.001). Positive independent prognostic indicators by multivariate analysis were complete cytoreduction, treatment by a second procedure, limited extent of PC, age less than 65 years, and use of adjuvant chemotherapy. The use of neoadjuvant chemotherapy, lymph node involvement, presence of liver metastasis and poor histological differentiation were negative independent prognostic indicators. The therapeutic approach combining cytoreductive surgery with perioperative intraperitoneal chemotherapy achieved long-term survival in carefully selected group of patients with PC from colorectal origin and offer a chance for cure or palliation in this condition. Further collaboration between peritoneal surface malignancy treatment centres are needed in order to standardize indications, intraperitoneal chemotherapy and peritonectomy techniques.
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Affiliation(s)
- F N Gilly
- Surgical Department, Centre Hospitalo Universitaire Lyon Sud, 69495 Pierre Bénite Cedex, France.
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Glehen O, Cotte E, Lifante JC, Arvieux C, Moles N, Brigand C, Beaujard AC, François Y, Gilly FN. Peritoneal carcinomatosis in digestive cancers: cytoreductive surgery combined with intraperitoneal chemohyperthermia. The experience in Centre Hospitalier et Universitaire Lyon Sud (CHLS). Acta Chir Belg 2006; 106:285-90. [PMID: 16910000 DOI: 10.1080/00015458.2006.11679894] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Intraperitoneal chemohyperthermia (IPCH) with Cytoreductive surgery (CS) has been used in Centre Hospitalier et Universitaire Lyon Sud (CHLS) since 1989. Up to 2005, 420 patients were involved in different phase II studies for peritoneal carcinomatosis (PC) from colorectal, gastric or ovarian origin, as well as for pseudomyxoma peritonei and peritoneal mesothelioma. Encouraging results were achieved in case of optimal PC cytoreduction. The CHLS experience, as well as the Dutch randomized trial and the international registration, underline the advantage of such an aggressive combined therapy for selected patients in experienced multidisciplinary centers.
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Affiliation(s)
- O Glehen
- Department of surgery, Centre Hospitalier et Universitaire Lyon Sud, HCL, 69495, Pierre Bénite cedex, France
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Glehen O, Cotte E, Brigand C, Arvieux C, Sayag-Beaujard AC, Gilly FN. Nouveautés thérapeutiques dans la prise en charge des carcinoses péritonéales d'origine digestive : chirurgie de cytoréduction et chimiothérapie intrapéritonéale. Rev Med Interne 2006; 27:382-91. [PMID: 16236392 DOI: 10.1016/j.revmed.2005.08.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2005] [Accepted: 08/23/2005] [Indexed: 01/26/2023]
Abstract
PURPOSE Peritoneal carcinomatosis and particularly those from digestive origin has long been considered as an automatically terminal disease in abdominal cancer patients. CURRENT KNOWLEDGE AND KEY POINTS Over the past decade, new locoregional treatments combining cytoreductive surgery, peritonectomy procedures with perioperative intraperitoneal chemotherapy (with or without hyperthermia) have been developed by specialized teams. Because of its high but acceptable mortality and morbidity, this aggressive but comprehensive therapeutic strategy requires accurate and strict patient's selection into multidisciplinary and specialized teams. It may allow prolonged survival and cure for patients with pseudomyxoma peritonei, peritoneal mesothelioma, carcinomatosis from colorectal or gastric cancer. Qualitative and quantitative prognostic indicators are needed to assess a patient's eligibility, including tumor histopathology, assessment of carcinomatosis extent or completeness of cytoreduction which appears to be the most important. PERSPECTIVES Combination of cytoreductive surgery with perioperative intraperitoneal chemotherapy appears to be an adapted therapeutic approach for patients strictly selected, with peritoneal carcinomatosis. Phase III studies are now needed for the validation and the evaluation of the type of intraperitoneal chemotherapy.
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Affiliation(s)
- O Glehen
- Service de Chirurgie Générale, Thoracique et Endocrinienne, Centre Hospitalo-Universitaire Lyon-Sud, 69495 Pierre-Bénite, cedex France.
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Gilly FN, Cotte E, Brigand C, Monneuse O, Beaujard AC, Freyer G, Glehen O. Quantitative prognostic indices in peritoneal carcinomatosis. Eur J Surg Oncol 2006; 32:597-601. [PMID: 16617003 DOI: 10.1016/j.ejso.2006.03.002] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2005] [Accepted: 03/02/2006] [Indexed: 11/19/2022] Open
Abstract
Five different descriptions quantitating peritoneal carcinomatosis are available: the Lyon staging system, the Peritoneal Cancer Index (PCI), the Japanese Research Society for Gastric Cancer carcinomatosis staging (JRSGS), the Dutch simplified peritoneal carcinomatosis assessment and the Completeness of Cytoreduction Score (CCR). These five staging systems are described and discussed. Combinations of these to achieve a complete description of peritoneal lesions prior to and following treatment assist in a correct prognostic assessment for these patients and in a selection of treatment options.
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Affiliation(s)
- F N Gilly
- Surgical Department, Centre Hospitalo-Universitaire Lyon-Sud, 69495 Pierre Bénite Cedex, France.
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Brigand C, Monneuse O, Mohamed F, Sayag-Beaujard AC, Isaac S, Gilly FN, Glehen O. Peritoneal mesothelioma treated by cytoreductive surgery and intraperitoneal hyperthermic chemotherapy: results of a prospective study. Ann Surg Oncol 2006; 13:405-12. [PMID: 16485159 DOI: 10.1245/aso.2006.05.041] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2005] [Accepted: 09/08/2005] [Indexed: 01/08/2023]
Abstract
BACKGROUND Peritoneal mesothelioma is a rare disease with few therapeutic options. Recently, the combination of cytoreductive surgery with intraperitoneal hyperthermic chemotherapy (HIPEC) has shown promising results. METHODS Fifteen patients with peritoneal mesothelioma who were treated by cytoreductive surgery and HIPEC between 1989 and 2004 were identified from a prospective database. HIPEC was performed with cisplatin and mitomycin C for 90 minutes by using the closed-abdomen technique. RESULTS All patients but one (multicystic) had malignant disease of the following pathologic types: 12 epithelial and 2 biphasic. After surgical resection, 11 patients were considered to have a CC-0 or CC-1 resection (macroscopic complete resection or diameter of residual nodules <2.5 mm). No postoperative death occurred, and six postoperative complications were recorded. All but one patient had resolution of ascites. The overall median survival for the 14 patients with malignant mesothelioma was 35.6 months. The median survival was 37.8 months for patients treated with a CC-0 or CC-1 resection, whereas it was 6.5 months for those treated with a CC-2 or CC-3 resection (diameter of residual nodules >2.5 mm; P < .001). In a univariate analysis, the only other significant prognostic factor was the carcinomatosis extent (P = .02). CONCLUSIONS A therapeutic strategy combining cytoreductive surgery with HIPEC seems to provide an adequate and efficient locoregional treatment for peritoneal mesothelioma. It is associated with acceptable morbidity when performed by an experienced surgical team. The completeness of cytoreduction is the major determinant of survival.
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Affiliation(s)
- C Brigand
- Department of General Surgery, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
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Loungnarath R, Causeret S, Brigand C, Gilly FN, Glehen O. [Pseudomyxoma peritonei: new concept and new therapeutic approach]. ACTA ACUST UNITED AC 2004; 130:63-9. [PMID: 15737316 DOI: 10.1016/j.anchir.2004.09.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2004] [Accepted: 09/30/2004] [Indexed: 01/14/2023]
Abstract
Pseudomyxoma peritonei is a rare disease, usually diagnosed after the discover of "jelly belly" by laparotomy. With the progress of immunohistochemistry, most authors now acknowledge the appendix to be the principal origin of this disease. Pseudomyxoma peritonei need to considered as border line malignant disease because of its inevitable persistence and progression without adapted therapeutic approach: cytoreductive surgery combined with perioperative intraperitoneal chemotherapy (intraperitoneal chemohyperthermia and/or immediate postoperative intraperitoneal chemotherapy) into specialized centres. The principal prognostic factors are the prior surgical history, the completeness of cytoreduction and especially the histopathologic grade.
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Affiliation(s)
- R Loungnarath
- Département de chirurgie colorectale, centre hospitalier de l'université de montréal, hôpital Saint-Luc, Montréal, Québec, Canada
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Glehen O, Cotte E, Schreiber V, Sayag-Beaujard AC, Vignal J, Gilly FN. Intraperitoneal chemohyperthermia and attempted cytoreductive surgery in patients with peritoneal carcinomatosis of colorectal origin. Br J Surg 2004; 91:747-54. [PMID: 15164446 DOI: 10.1002/bjs.4473] [Citation(s) in RCA: 156] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Colorectal cancer with peritoneal carcinomatosis is usually considered incurable. The purpose of this study was to evaluate the efficacy of intraperitoneal chemohyperthermia (IPCH) following cytoreductive surgery in patients with colorectal carcinomatosis. METHODS Between January 1989 and August 2002, 53 patients (mean age 48.6 years) were treated by IPCH with mitomycin C. IPCH was performed in 34 patients following extensive cytoreductive surgery (more than two peritonectomy procedures). Five patients underwent two operations and one patient three operations. RESULTS Operative morbidity and mortality rates were 23 and 4 per cent respectively. At a median follow-up of 59.5 months, the overall median survival was 12.8 months. The extent of carcinomatosis, completeness of cytoreduction and histological differentiation were significant prognostic indicators by univariate analysis. The median survival was 32.9 months for patients whose resection was classified as completeness of cancer resection (CCR) 0 (complete cytoreduction), 12.5 months for those whose operation was CCR-1 (diameter of residual nodules 5 mm or less) and 8.1 months for patients who had a CCR-2 resection (diameter of residual nodules more than 5 mm) (P < 0.001). Completeness of cytoreduction was the only significant independent predictor of survival by multivariate analysis. CONCLUSION IPCH combined with cytoreductive surgery seems to be an effective therapy for carefully selected patients with carcinomatosis from colorectal cancer. This strategy was most effective in patients with carcinomatosis of limited tumour volume or when cytoreductive surgery allowed sufficient downstaging (residual tumour nodules smaller than 5 mm).
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Affiliation(s)
- O Glehen
- Department of Surgery, Centre Hospitalier Lyon-Sud, Pierre Bénite, France
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Glehen O, Osinsky D, Cotte E, Kwiatkowski F, Freyer G, Isaac S, Trillet-Lenoir V, Sayag-Beaujard AC, François Y, Vignal J, Gilly FN. Intraperitoneal chemohyperthermia using a closed abdominal procedure and cytoreductive surgery for the treatment of peritoneal carcinomatosis: morbidity and mortality analysis of 216 consecutive procedures. Ann Surg Oncol 2004; 10:863-9. [PMID: 14527903 DOI: 10.1245/aso.2003.01.018] [Citation(s) in RCA: 285] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Peritoneal carcinomatosis has been regarded as a lethal clinical entity. Recently, aggressive treatments combining intraperitoneal chemohyperthermia (IPCH) with cytoreductive surgery have resulted in long-term survival in selected patients. The aim of this trial was to analyze the mortality and morbidity of 216 consecutive treatments of peritoneal carcinomatosis by IPCH by using a closed abdominal procedure combined with cytoreductive surgery. METHODS Between February 1989 and August 2001, 207 patients who underwent 216 IPCH procedures using a closed abdominal procedure with mitomycin C, cisplatin, or both were prospectively studied. RESULTS The postoperative mortality and morbidity rates were 3.2% and 24.5%, respectively. The most frequent complications were digestive fistula (6.5%) and hematological toxicity (4.6%). Morbidity was statistically linked with the carcinomatosis stage (P =.016), the duration of surgery (P =.005), and the number of resections and peritonectomy procedures (P =.042). Duration of surgery and carcinomatosis stage were the most common predictors of morbidity. CONCLUSIONS The frequency of complications after IPCH and cytoreductive surgery was mainly associated with the carcinomatosis stage and the extent of the surgical procedure. The IPCH closed abdominal procedure has shown an acceptable frequency of adverse events.
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Affiliation(s)
- O Glehen
- Department of Surgery, Centre Hospitalier Lyon-Sud, Pierre Bénite Cédex, France
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Glehen O, Schreiber V, Cotte E, Sayag-Beaujard AC, Osinsky D, Freyer G, François Y, Vignal J, Gilly FN. Cytoreductive surgery and intraperitoneal chemohyperthermia for peritoneal carcinomatosis arising from gastric cancer. ACTA ACUST UNITED AC 2004; 139:20-6. [PMID: 14718269 DOI: 10.1001/archsurg.139.1.20] [Citation(s) in RCA: 168] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
HYPOTHESIS The most common cause of palliative resection and recurrence in gastric cancer is peritoneal seeding. This study evaluates the efficacy of intraperitoneal chemohyperthermia after cytoreductive surgery in patients with peritoneal carcinomatosis arising from gastric cancer. DESIGN Prospective clinical trial. SETTING Surgical department at a university academic hospital. PATIENTS Forty-nine consecutive patients with peritoneal carcinomatosis treated between January 1, 1989, and February 29, 2000. INTERVENTIONS All patients underwent intraperitoneal chemohyperthermia with mitomycin C (40-60 mg); 21 patients had previously undergone extensive cytoreductive surgery. MAIN OUTCOME MEASURES Clinicopathologic factors that affect overall survival rates. RESULTS With median follow-up of 99 months, overall median survival was 10.3 months. Two factors were significant independent predictors of survival by multivariate analysis: preoperative ascites (P =.04) and completeness of cancer resection (CCR) by cytoreductive surgery (P<.001). Median survival was 21.3 months for patients with CCR-0 (macroscopic complete resection) or CCR-1 (diameter of residual nodules <5 mm) and 6.1 months for patients with CCR-2 (diameter of residual nodules >5 mm) (P<.001). Four patients survived longer than 5 years. CONCLUSIONS An aggressive management strategy combining intraperitoneal chemohyperthermia with cytoreductive surgery is effective for patients with peritoneal carcinomatosis arising from gastric cancer. In highly selected patients (good general status, resectable primary tumor, resectable peritoneal carcinomatosis), this therapy may result in long-term survival.
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Affiliation(s)
- O Glehen
- Department of Surgery, Centre Hospitalier Lyon-Sud, Pierre Bénite, France
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Abstract
Peritoneal carcinomatosis may occur after curative surgery of any gastrointestinal carcinoma, but it is however the most frequent form of evolution after curative resection of gastric carcinoma and is present at the time of surgery in many cases. This locoregional extension of cancer has a poor prognosis, with a great mortality and a poor quality of life. It is sometimes considered of such a poor prognosis that patients do not go through any resection or palliative procedure. Techniques of radiotherapy, chemotherapy and intraperitoneal chemotherapy have been used with moderate clinical efficacy. Since the 1990s, intraoperative hyperthermic peritoneal chemotherapy combined with comprehensive cytoreductive surgery has been proposed to improve prognosis of patients with peritoneal carcinomatosis from gastric origin as well as carcinomatosis from colorectal origin or pseudomyxoma peritonei.
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Affiliation(s)
- C Brigand
- Service de Chirurgie Generale et Digestive, Hopital Hautepierre, Strasbourg, France
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Cherki S, Glehen O, Moutardier V, François Y, Gilly FN, Vignal J. Pouch adenocarcinoma after restorative proctocolectomy for familial adenomatous polyposis. Colorectal Dis 2003; 5:592-4. [PMID: 14617250 DOI: 10.1046/j.1463-1318.2003.00486.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abstract
Peritoneal carcinomatosis should no longer be considered as an automatically terminal disease in abdominal cancer patients. The aim of this comprehensive review of the literature was to evaluate the indications and contraindications of intraperitoneal hyperthermic chemotherapy with extensive cytoreduction surgery. Several aspects of the procedure are detailed. Feasibility, short-term and survival results are analysed owing to a comprehensive review of published studies.
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Affiliation(s)
- K Slim
- Service de chirurgie générale et digestive, Hôtel-Dieu, boulevard Léon-Malfreyt, 63058, Clermont-Ferrand, cedex 1, France.
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Abstract
The special issue (Special Issue on Colorectal Cancer, Volume 92, number 1: 1–108, 2003) of the journal dedicated to new techniques and modern treatment modalities concerning colorectal cancer was most informative; yet we were perplexed with the absence of comment or review regarding the new management strategies for peritoneal carcinomatosis. Despite advances in the early detection of colon and rectal cancer, carcinomatosis remains a major problem for these patients. It is detected in approximately 10 % of patients at the time of primary cancer resection (1). In contrast to the two other major anatomic sites for colorectal dissemination (lymph node and liver metastases) peritoneal carcinomatosis has long been considered a terminal condition with no curative treatment options. For example, in a multicentric prospective study on the natural history of carcinomatosis from nongynaecologic malignancies, the median overall survival was 5.2 months for colorectal patients (2). In a more recent retrospective analysis of 3019 colorectal cancer patients, 13 % of patients presented with carcinomatosis and had a median survival of 7 months (3). During the last decade there has been an increasing interest in a combined treatment of peritoneal carcinomatosis with cytoreductive surgery and perioperative intraperitoneal chemotherapy. The concept of tumour volume reduction of peritoneal surface malignancy which has been reported in the past for ovarian cancer and its combination with a local-regional chemotherapy acts as a “dose intensification device” that allows a potentially curative treatment option. Theoretically, cytoreductive surgery and its peritonectomy procedures is performed to treat the macroscopic disease and perioperative intraperitoneal chemotherapy to treat residual microscopic residual disease.
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Affiliation(s)
- O Glehen
- Surgical Department, Centre Hospitalo-Universitaire Lyon Sud, 69495 Pierre Bénite, France
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Glehen O, Lifante JC, Vignal J, Francois Y, Gilly FN, Flourié B, Descos L, Chung RJH, Mithieux F. Small bowel length in Crohn's disease. Int J Colorectal Dis 2003; 18:423-7. [PMID: 12687393 DOI: 10.1007/s00384-002-0475-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2002] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS This prospective study compared jejunoileal length in patients with Crohn's disease (CD) and the general population to determine whether this parameter can be related to outcome and management of CD complications. PATIENTS AND METHODS Small bowel (SB) length was measured during abdominal surgery prior to bowel resection in 93 patients with CD and 92 patients without inflammatory or small bowel disease. RESULTS SB length was shown to be shorter in patients with CD (462 vs. 567 cm) and was correlated to sex and height. There was no correlation of SB length to clinical expression (perforating or nonperforating), site, or outcome. SB length is not a prognosis factor of postoperative relapse. The presence of perineal disease and systemic abnormalities seem to be the only prognostic factors of surgical recurrence. Sex, age at onset, time of first surgery, site of disease, and mode of onset are not predictive of surgical recurrence. CONCLUSION We recommend minimal intestinal resection when surgical treating CD complications in patients at high risk of surgical relapse and initial short SB. We advise using stricturoplasty or leaving asymptomatic intestinal lesions to reduce short bowel syndrome occurrence when performing iterative surgery.
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Affiliation(s)
- O Glehen
- Surgical Department, Centre Hospitalo-Universitaire Lyon-Sud, 69495 Lyon-Pierre Bénite, France
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Monneuse O, Beaujard AC, Guibert B, Gilly FN, Mulsant P, Carry PY, Benoit M, Glehen O. Long-term results of intrathoracic chemohyperthermia (ITCH) for the treatment of pleural malignancies. Br J Cancer 2003; 88:1839-43. [PMID: 12799624 PMCID: PMC2741113 DOI: 10.1038/sj.bjc.6601000] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
There is no standard treatment for patients with pleural malignancies. The aim of this prospective study was to investigate the toxicity and long-term results of a multimodality treatment consisting of surgery and intrathoracic chemohyperthermia (ITCH) for the treatment of patients with pleural malignancies. From January 1990 to August 2000, 24 patients with mesothelioma (n=17), fibrosarcoma (n=3), pleural adenocarcinoma (n=3) and thymoma (n=1) were included. The mesothelioma stages were T1 or T2 in 10 cases, and T3 or T4 in seven cases. After cytoreductive surgery, ITCH was carried out for over 60 min, at inflow temperatures less than 45 degrees C, either with mitomycin C (n=7) or cisplatin (n=5) or both (n=12). One patient died from major thoracic air leaks after major decortication and pleurectomy. Seven patients had complications, one pleural clotting necessitating reoperation. After a median follow-up of 89 months, the overall 1-year and 5-year survival rates were 74 and 27%, respectively. For T1 and T2 mesothelioma patients, the median survival was 41.3 months, and for T3 and T4 tumours, it was 4.5 months (P=0.001). The fibrosarcoma patients are alive with no evidence of recurrence at 24, 43 and 54 months. In the conclusion, the combination of surgery with ITCH with mitomycin and/or cisplatin is relatively safe. This procedure may offer unexpected long-term survival in a selected group of patients (T1 and T2 mesothelioma patients and fibrosarcoma patients).
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Affiliation(s)
- O Monneuse
- EA ‘Ciblage Thérapeutique en Oncologie, Université Lyon 1, Faculté Lyon Sud, 69310, Oullins, France
| | - A C Beaujard
- EA ‘Ciblage Thérapeutique en Oncologie, Université Lyon 1, Faculté Lyon Sud, 69310, Oullins, France
- Anesthesiologia and Intensive Care Unit, Centre Hospitalo-Universitaire Lyon Sud, 69495 Pierre Bénite, France
| | - B Guibert
- Surgical Department, Centre Hospitalo-Universitaire Lyon Sud, 69495 Pierre Bénite, France
| | - F N Gilly
- EA ‘Ciblage Thérapeutique en Oncologie, Université Lyon 1, Faculté Lyon Sud, 69310, Oullins, France
- Surgical Department, Centre Hospitalo-Universitaire Lyon Sud, 69495 Pierre Bénite, France
- Surgical Department, Centre Hospitalo Universitaire Lyon sud, 69495 Pierre Bénite cedex, France. E-mail:
| | - P Mulsant
- Surgical Department, Centre Hospitalo-Universitaire Lyon Sud, 69495 Pierre Bénite, France
| | - P Y Carry
- Anesthesiologia and Intensive Care Unit, Centre Hospitalo-Universitaire Lyon Sud, 69495 Pierre Bénite, France
| | - M Benoit
- Anesthesiologia and Intensive Care Unit, Centre Hospitalo-Universitaire Lyon Sud, 69495 Pierre Bénite, France
| | - O Glehen
- EA ‘Ciblage Thérapeutique en Oncologie, Université Lyon 1, Faculté Lyon Sud, 69310, Oullins, France
- Surgical Department, Centre Hospitalo-Universitaire Lyon Sud, 69495 Pierre Bénite, France
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Glehen O, Peyrat P, Beaujard AC, Chapet O, Romestaing P, Sentenac I, Francois Y, Vignal J, Gérard JP, Gilly FN. Pattern of failures in gastric cancer patients with lymph node involvement treated by surgery, intraoperative and external beam radiotherapy. Radiother Oncol 2003; 67:171-5. [PMID: 12812847 DOI: 10.1016/s0167-8140(02)00344-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIMS High local failure rates in gastric cancer have been reported, up to 67%. To achieve a better local control, we evaluated intraoperative radiotherapy (IORT) and external beam radiotherapy (EBRT) in association with surgery for gastric cancer patients with lymph node involvement. We report here the analysis of the patterns of failure for patients involved in this IORT protocol. MATERIAL AND METHODS Forty-two positive lymph node (N+) gastric cancer patients were operated on (31 total, three subtotal and eight extended gastrectomies) with IORT procedure between 1985 and 1997 (33 males, nine females, mean age 61.3 years). IORT was focused on coeliac area (mean dose 15 Gy), followed by EBRT (46 Gy) in 36 patients. Ten patients were pN1 and 32 were pN2. A concurrent systemic chemotherapy (five Fluoro-Uracil and Cisplatinum) was performed in 14 patients. RESULTS One patient died postoperatively. Actuarial pN+ 10 year survival rate was 44.8%. The 5 year actuarial local control and disease-free survival rates were 78.8 and 47.5%, respectively. As far as patterns of failure were explored, 5 patients have a local coeliac recurrence (12%) and 12 have distant metastases with no evidence of coeliac recurrence. CONCLUSION This retrospective analysis suggests a potential effect of IORT and/or EBRT in promoting local control and long-term survival in gastric cancer patients with lymph node involvement.
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Affiliation(s)
- O Glehen
- EA 643, Université Claude Bernard, Lyon 1, France
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Glehen O, Mithieux F, Osinsky D, Beaujard AC, Freyer G, Guertsch P, Francois Y, Peyrat P, Panteix G, Vignal J, Gilly FN. Surgery combined with peritonectomy procedures and intraperitoneal chemohyperthermia in abdominal cancers with peritoneal carcinomatosis: a phase II study. J Clin Oncol 2003; 21:799-806. [PMID: 12610177 DOI: 10.1200/jco.2003.06.139] [Citation(s) in RCA: 207] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
PURPOSE To evaluate the tolerance of peritonectomy procedures (PP) combined with intraperitoneal chemohyperthermia (IPCH) in patients with peritoneal carcinomatosis (PC), a phase II study was carried out from January 1998 to September 2001. PATIENTS AND METHODS Fifty-six patients (35 females, mean age 49.3) were included for PC from colorectal cancer (26 patients), ovarian cancer (seven patients), gastric cancer (six patients), peritoneal mesothelioma (five patients), pseudomyxoma peritonei (seven patients), and miscellaneous reasons (five patients). Surgeries were performed mainly on advanced patients (40 patients stages 3 and 4 and 16 patients stages 2 and 1) and were synchronous in 36 patients. All patients underwent surgical resection of their primary tumor with PP and IPCH (with mitomycin C, cisplatinum, or both) with a closed sterile circuit and inflow temperatures ranging from 46 degrees to 48 degrees C. Three patients were included twice. RESULTS A macroscopic complete resection was performed in 27 cases. The mortality and morbidity rates were one of 56 and 16 of 56, respectively. The 2-year survival rate was 79.0% for patients with macroscopic complete resection and 44.7% for patients without macroscopic complete resection (P =.001). For the patients included twice, two are alive without evidence of disease, 54 and 47 months after the first procedure. CONCLUSION IPCH and PP are able to achieve unexpected long-term survival in patients with bulky PC. However, one must be careful when selecting the patients for such an aggressive treatment, as morbidity rate remains high even for an experienced team.
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Affiliation(s)
- O Glehen
- Surgical Department, Anesthesiology and Intensive Care Unit, Medical Oncology Department, Centre Hospitalo-Universitaire Lyon Sud, Pierre Bénite, France
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Paparel P, François Y, Lifante JC, Gilly FN, Vignal J. [A case of recto-urethral fistula in Crohn's disease]. Prog Urol 2001; 11:331-3. [PMID: 11400502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
The authors report the fourteenth case of rectourethral fistula associated with Crohn's disease, in a 53-year-old man with a 20-year history of ileocolonic Crohn's disease. The patient developed a rectourethral fistula following an episode of complex anoperineal suppuration surgically exposed on several occasions. Repeated surgical exposure and urine drainage were not sufficient to close the fistula and cure the perineal suppuration. After 10 months, the patient was treated by the rectal mucosal transposition flap technique to close the rectal aspect of the fistula, which ensured cure of the patient's fistula and anoperineal lesions. This technique has been used successfully on 4 occasions and appears to be an effective treatment for rectourethral fistula in Crohn's disease with healthy rectal mucosa.
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Affiliation(s)
- P Paparel
- Service de Chirurgie générale et digestive, Centre Hospitalier Lyon Sud, 69495 Pierre-Bénite.
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Lifante JC, Glehen O, Peyrat P, Paparel P, Francois Y, Gilly FN, Vignal J. [Segmental resection of tumoral invasion of the inferior vena cava without reconstruction]. Ann Chir 2001; 126:46-50. [PMID: 11255971 DOI: 10.1016/s0003-3944(00)00457-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
STUDY AIM Oncological complete surgery of retroperitoneal tumours may require segmental resection of part of the invaded inferior vena cava. The aim of this retrospective study was to assess whether reconstruction of the inferior vena cava is necessary and presents any advantage. PATIENTS AND METHODS This study included four patients who underwent partial resection of the inferior vena cava invaded by a retroperitoneal tumour, without reconstruction. Tumours were one renal cancer, one malignant phaeochromocytoma, one malignant retroperitoneal histiofibroma and one undifferentiated retroperitoneal carcinoma. The resection was located at the level of the renal confluence, associated with right nephrectomy, in 3 patients, and above this confluence, at the level of the retrohepatic inferior vena cava in 1 patient. RESULTS Only one case of transient acute renal failure was observed during the postoperative course. One patient developed right deep vein thrombosis after three months and another one after 30 months. One patient died from cancer recurrence after 19 months. The other 3 patients were alive with anticoagulant therapy and without sequelae after 3, 6 and 15 years.
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Affiliation(s)
- J C Lifante
- Service de chirurgie générale et thoracique, centre hospitalier universitaire Lyon-Sud, 69495 Pierre-Bénite, France
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Peyrègne V, François Y, Isaac S, Grandclément E, Sadeghi-Looyeh B, Sayag-Beaujard A, Vignal J, Gilly FN. Liver cystadenocarcinoma originating in cystadenoma without mesenchymal stroma. Therapeutic strategy in case of atypical radiological criteria. A case report. Hepatogastroenterology 2001; 48:247-9. [PMID: 11268975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Optimal treatment of cystadenoma if diagnosed consists of complete resection of the tumor. In case of atypical radiological criteria, therapeutic strategy is not well defined. The attitude we adopt is to regularly monitor the lesion. Surgical removal of the tumor is of course indicated facing any significant change on sonography or tomodensiometry.
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Affiliation(s)
- V Peyrègne
- Department of General and thoracic Surgery, University of Lyons, France
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Glehen O, Beaujard AC, Romestaing P, Sentenac I, François Y, Peyrat P, Braillon G, Vignal J, Gérard JP, Gilly FN. Intraoperative radiotherapy and external beam radiation therapy in gastric adenocarcinoma with R0-R1 surgical resection. Eur J Surg Oncol 2000; 26 Suppl A:S10-2. [PMID: 11130872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
INTRODUCTION The aims of this study were to evaluate the results of intraoperative radiotherapy (IORT) and external beam therapy (EBRT) in the treatment of gastric adenocarcinoma. METHODS From 1986 to 1999, 87 patients who underwent surgical resection for gastric adenocarcinoma combined with IORT were reviewed. A R0 surgical resection was performed in 82 patients and five underwent R1 resection. The stage was: pT1 in 12, pT2 in 19, pT3 in 44 and pT4 in seven. Thirteen patients were pN1 and 43 were pN2, The IORT dose ranged from 12 to 23 Gy. Patients with pT3 and/or pN tumours underwent EBRT with a standard dose of 44-46 Gy. RESULTS The post-operative mortality and morbidity rates were 2.3 and 6.8%, respectively. The 5-year survival rate for R0 patients was 60%, for R0-pN0 was 90% and for R0-pN+ patients was 55%. The local failure rate in the 19 pN+ patients was 21%. CONCLUSION IORT and EBRT combined with surgical resection may provide overall survival, improving the local control after gastrectomy.
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Affiliation(s)
- O Glehen
- Université Claude Bernard, Lyon 1, France
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Glehen O, Traverse-Glehen A, Peyrat P, François Y, Gérard JP, Vignal J, Gilly FN. [Stomach adenocarcinoma. Evolution of surgical treatment in a series of 350 cases]. Ann Chir 2000; 125:744-51. [PMID: 11105346 DOI: 10.1016/s0003-3944(00)00268-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
STUDY AIM The aim of this prospective study was to evaluate, in a series of 350 gastric adenocarcinomas, the evolution of their clinical and histological features and the evolution of their surgical management. PATIENTS AND METHODS From 1970 to 1996, 350 patients with gastric carcinoma (cardiac cancer excluded) were operated on in the same center. Mean age was 68.8 years and the sex ratio 1:4. These patients were divided into three groups which were analysed and compared (group 1 operated on between 1970 and 1988, group 2 between 1979 and 1987, group 3 between 1988 and 1996). RESULTS Antropyloric cancer was the most common (56% in group 3). Tumor size decreased but there were in group 3 more undifferentiated tumors (54.2%) and more tumors with lymph node involvement (72%). Stage III and IV tumors were still common (70% in group 3) and early gastric cancer incidence very low (9.9%). After 1980, surgical management was more radical, with more total gastrectomies and larger lymph node dissections. Adjuvant intraoperative and postoperative radiotherapy has been associated since 1985. Postoperative mortality rate decreased (13.8% in group 1 vs 6.1% in group 3) (P = 0.04) as did the postoperative morbidity rate (31.8% in group 1 vs 17.5% in group 3). The five-year actuarial survival rate was respectively 18.9% and 39.2% for groups 1 and 2 (P = 0.003); it was respectively 59.8% and 43.6% for all patients treated by adjuvant radiotherapy and for those with lymph node involvement. CONCLUSION Prognosis of gastric adenocarcinoma is still poor. A more radical surgical treatment did not increase the postoperative morbidity rate, but increased the survival rate. New adjuvant treatments including radiotherapy have to be evaluated in order to improve the prognosis.
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Affiliation(s)
- O Glehen
- Service de chirurgie viscérale et thoracique, centre hospitalier universitaire Lyon-Sud, Pierre-Bénite, France
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Beaujard AC, Glehen O, Caillot JL, Francois Y, Bienvenu J, Panteix G, Garbit F, Grandclément E, Vignal J, Gilly FN. Intraperitoneal chemohyperthermia with mitomycin C for digestive tract cancer patients with peritoneal carcinomatosis. Cancer 2000. [PMID: 10861427 DOI: 10.1002/1097-0142(20000601)88:11<2512::aid-cncr12>3.0.co;2-j] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Most patients with peritoneal carcinomatosis of digestive tract origin die within 6 months. Intraperitoneal chemohyperthermia (IPCH) associated with surgery has been reported as a possible new therapeutic approach. METHODS A prospective Phase II trial was carried out with 83 patients who had digestive tract cancer and peritoneal carcinomatosis to evaluate the tolerance and efficacy of IPCH with mitomycin C (MMC) associated with surgery. Eighty-six IPCH treatments with MMC were given as complementary therapy after surgery (peritoneal perfusate with a 10 mg/L dose of MMC; inflow temperature, 46-49 degrees C; use of a closed circuit; duration, 90 minutes). Primary tumors were mainly gastric (in 42 cases) or colorectal (in 27 cases). RESULTS Mortality and morbidity occurred in 3 of 83 cases and 8 of 83 cases, respectively. For patients with resectable tumors, the median survival time was 16 months when carcinomatosis was Stage I and II (malignant granulations less than 5 mm in greatest dimension), whereas it was 6 months when carcinomatosis was Stage III and IV (malignant granulations more than 5 mm in greatest dimension). For patients with resectable gastric cancer and Stage I and II carcinomatosis, 1-, 2-, and 3-year actuarial survival rates were 80%, 61%, and 41%, respectively, whereas the rate was 10% at 1 year for patients with bulky disease (Stage III and IV). CONCLUSIONS IPCH appears to be a promising new approach to treating patients with digestive tract cancers and peritoneal carcinomatosis with small, malignant granulations (Stage I and II).
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Affiliation(s)
- A C Beaujard
- Oncologic Hyperthermia Laboratory, Université C.B. Lyon-I, Oullins, France
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Rostom YA, Chapet O, Russo SM, Dubernard P, Maréchal JM, Sentenac I, Gilly FN, Gérard JP. Intra-operative electron radiotherapy as a conservative treatment for infiltrating bladder cancer. Eur J Cancer 2000; 36:1781-7. [PMID: 10974626 DOI: 10.1016/s0959-8049(00)00170-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The intent of this feasibility study was to evaluate the use of intra-operative electron radiotherapy (IOERT), after transurethral resection (TUR), combined with external beam radiation with concurrent chemotherapy for the conservative treatment of infiltrating bladder cancer. From November 1988 to June 1998, 27 patients with histologically proven non-metastatic infiltrating bladder cancer were included in this protocol. The treatment consisted of: TUR, external beam irradiation (x18 MV:48 Grays (Gy)/24 fractions/5 weeks), with concurrent chemotherapy (cisplatin 30 mg/day for 3 days-two cycles during irradiation), followed by control cystoscopy and cystotomy with IOERT (e 9 MeV:15 Gy). 14 patients received two cycles of neoadjuvant methotrexate, vinblastine and cisplatin (MVC) and folinic acid chemotherapy. Patients were evaluated for toxicity, local control and survival. The 5-year overall and cystectomy-free survival rates were 53.3% +/-11.1% and 48.1%+/-11.4%, respectively. 4 patients developed infiltrating intravesicular recurrence (3 were treated by salvage cystectomy), and an additional patient developed a superficial recurrence. 2 patients subsequently developed regional recurrence in pelvic nodes and 10 patients were found to have distant metastases. The protocol was found to be feasible and associated with acceptable toxicity. Early and late toxicities consisted of 3 cases of bladder mucosal necrosis or ureteral stenosis which resolved with medical management. These preliminary results indicate that IOERT combined with TUR and neoadjuvant external beam radiation with concurrent chemotherapy is feasible. It could be considered as an alternative therapy for infiltrating carcinoma of the bladder, especially in patients unfit for radical surgery, and is well adapted to treat lesions of the fixed portion of the bladder.
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Affiliation(s)
- Y A Rostom
- Department of Radiotherapy-Oncology, Department of Surgery, Centre Hospitalier, Lyon Sud, 69495, Pierre Benite Cedex, France
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Gilly FN, François Y, Sayag-Beaujard AC, Glehen O, Brachet A, Vignal J. Prevention of lymphorrhea by means of fibrin glue after axillary lymphadenectomy in breast cancer: prospective randomized trial. Eur Surg Res 2000; 30:439-43. [PMID: 9838238 DOI: 10.1159/000008611] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A prospective randomized trial was carried out to evaluate the efficacy of fibrin glue in preventing lymphorrhea after axillary lymphadenectomy in breast cancer. One hundred and eight breast cancer patients, operated on by two senior surgeons, were randomized into two groups: group 1 (n = 58) without fibrin glue and group 2 (n = 50) with 2 ml of fibrin glue applied to the axillary dissection area at the end of the lymphadenectomy procedure. Early postoperative morbidity was 2/58 and 0/50 in groups 1 and 2, respectively. Mean daily postoperative drainage was significantly greater in group 1. The mean cumulative drainage quantity 6 days after the operation was 407.8 ml and 214.4 ml in groups 1 and 2, respectively (p = 0.001). The mean postoperative hospital stay was 10.1 days and 8.0 days in groups 1 and 2, respectively (p = 0.006). One delayed seroma was observed in each group. Fibrin glue seems to reduce daily postoperative drainage and hospital stay, but did not affect delayed seroma formation after axillary lymphadenectomy for breast cancer.
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Affiliation(s)
- F N Gilly
- Department of Surgery, Centre Hospitalo-Universitaire Lyon-Sud, Pierre-Bénite, France.
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Glehen O, Caillot JL, François Y, Peyrat P, Sadeghi Loyeeh B, Griot JB, Gilly FN, Vignal J. [Splenectomy for splenomegaly of more than 1000 grams. A retrospective study of 36 patients]. Ann Chir 2000; 51:1099-105. [PMID: 10868032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Splenectomy for massive splenomegaly is frequently performed for hematologic disorders for diagnostic and therapeutic indications. The role of splenectomy is complex and controversial. The aims of our retrospective study were to focus on postoperative complications and advantages of splenectomy for massive splenomegaly. Thirty six patients with splenomegaly weighing 1000 g or more, underwent splenectomy at Centre Hospitalier Universitaire Lyon Sud, from January 1st, 1982, to December 31, 1995. Thirty-one (85%) of these patients had hematologic malignancy and more than half of them were older than sixty years. The main indications for splenectomy were hypersplenism (18 patients) and diagnosis (14). Preliminary ligation of the splenic artery was performed in 25 patients (42%). All patients had drainage. The mortality and morbidity rates were 5.5% and 20%, respectively. No major septic or thromboembolic complications occurred. There was only one major bleeding complication. The advantages of splenectomy included histopathological diagnosis in 13 of 14 patients with splenomegaly of unknown origin, permanent pain relief in all cases, and immediate correction of hematological cytopenia in 27 cases (75%). We conclude that the large weight of the spleen does not constitute a contraindication to splenectomy, but indications must be carefully selected, and the operative and perioperative management, must be appropriate.
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Affiliation(s)
- O Glehen
- Laboratoire de Recherche Hyperthermie-Oncologie, Faculté de Médecine Lyon Sud, Oullins
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Beaujard AC, Glehen O, Caillot JL, Francois Y, Bienvenu J, Panteix G, Garbit F, Grandclément E, Vignal J, Gilly FN. Intraperitoneal chemohyperthermia with mitomycin C for digestive tract cancer patients with peritoneal carcinomatosis. Cancer 2000; 88:2512-9. [PMID: 10861427 DOI: 10.1002/1097-0142(20000601)88:11<2512::aid-cncr12>3.0.co;2-j] [Citation(s) in RCA: 138] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Most patients with peritoneal carcinomatosis of digestive tract origin die within 6 months. Intraperitoneal chemohyperthermia (IPCH) associated with surgery has been reported as a possible new therapeutic approach. METHODS A prospective Phase II trial was carried out with 83 patients who had digestive tract cancer and peritoneal carcinomatosis to evaluate the tolerance and efficacy of IPCH with mitomycin C (MMC) associated with surgery. Eighty-six IPCH treatments with MMC were given as complementary therapy after surgery (peritoneal perfusate with a 10 mg/L dose of MMC; inflow temperature, 46-49 degrees C; use of a closed circuit; duration, 90 minutes). Primary tumors were mainly gastric (in 42 cases) or colorectal (in 27 cases). RESULTS Mortality and morbidity occurred in 3 of 83 cases and 8 of 83 cases, respectively. For patients with resectable tumors, the median survival time was 16 months when carcinomatosis was Stage I and II (malignant granulations less than 5 mm in greatest dimension), whereas it was 6 months when carcinomatosis was Stage III and IV (malignant granulations more than 5 mm in greatest dimension). For patients with resectable gastric cancer and Stage I and II carcinomatosis, 1-, 2-, and 3-year actuarial survival rates were 80%, 61%, and 41%, respectively, whereas the rate was 10% at 1 year for patients with bulky disease (Stage III and IV). CONCLUSIONS IPCH appears to be a promising new approach to treating patients with digestive tract cancers and peritoneal carcinomatosis with small, malignant granulations (Stage I and II).
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Affiliation(s)
- A C Beaujard
- Oncologic Hyperthermia Laboratory, Université C.B. Lyon-I, Oullins, France
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Sadeghi B, Arvieux C, Glehen O, Beaujard AC, Rivoire M, Baulieux J, Fontaumard E, Brachet A, Caillot JL, Faure JL, Porcheron J, Peix JL, François Y, Vignal J, Gilly FN. Peritoneal carcinomatosis from non-gynecologic malignancies: results of the EVOCAPE 1 multicentric prospective study. Cancer 2000. [PMID: 10640968 DOI: 10.1002/(sici)1097-0142(20000115)88] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Peritoneal carcinomatosis (PC) is a common evolution of digestive cancer, associated with a poor prognosis. Yet it is poorly documented in the literature. METHODS Three hundred seventy patients with PC from non-gynecologic malignancies were followed prospectively: the PC was of gastric origin in 125 cases, of colorectal origin in 118 cases, of pancreatic origin in 58 cases, of unknown origin in 43 cases, and of miscellaneous origins in 26 cases. A previously reported PC staging system was used to classify these 370 patients. RESULTS Mean and median overall survival periods were 6.0 and 3.1 months, respectively. Survival rates were mainly affected by the initial PC stage (9.8 months for Stage I with malignant peritoneal granulations less than 5 mm in greatest dimension, versus 3.7 months for Stage IV with large, malignant peritoneal masses more than 2 cm in greatest dimension). The presence of ascites was associated with poor survival of patients with gastric or pancreatic carcinoma. Differentiation of the primary tumor did not influence the prognoses of patients with PC. CONCLUSIONS A better knowledge of the natural history of PC is needed, in view of the many Phase I, II, and III trials currently being conducted to evaluate aggressive multimodal therapeutic approaches to treating patients with PC from non-gynecologic malignancies.
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Affiliation(s)
- B Sadeghi
- Surgical Department, Centre Hospitalo Universitaire (CHU) Lyon Sud, Lyon Pierre Bénite, France
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Sadeghi B, Arvieux C, Glehen O, Beaujard AC, Rivoire M, Baulieux J, Fontaumard E, Brachet A, Caillot JL, Faure JL, Porcheron J, Peix JL, François Y, Vignal J, Gilly FN. Peritoneal carcinomatosis from non-gynecologic malignancies: results of the EVOCAPE 1 multicentric prospective study. Cancer 2000. [PMID: 10640968 DOI: 10.1002/(sici)1097-0142(20000115)88:23.0.co;2-o] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Peritoneal carcinomatosis (PC) is a common evolution of digestive cancer, associated with a poor prognosis. Yet it is poorly documented in the literature. METHODS Three hundred seventy patients with PC from non-gynecologic malignancies were followed prospectively: the PC was of gastric origin in 125 cases, of colorectal origin in 118 cases, of pancreatic origin in 58 cases, of unknown origin in 43 cases, and of miscellaneous origins in 26 cases. A previously reported PC staging system was used to classify these 370 patients. RESULTS Mean and median overall survival periods were 6.0 and 3.1 months, respectively. Survival rates were mainly affected by the initial PC stage (9.8 months for Stage I with malignant peritoneal granulations less than 5 mm in greatest dimension, versus 3.7 months for Stage IV with large, malignant peritoneal masses more than 2 cm in greatest dimension). The presence of ascites was associated with poor survival of patients with gastric or pancreatic carcinoma. Differentiation of the primary tumor did not influence the prognoses of patients with PC. CONCLUSIONS A better knowledge of the natural history of PC is needed, in view of the many Phase I, II, and III trials currently being conducted to evaluate aggressive multimodal therapeutic approaches to treating patients with PC from non-gynecologic malignancies.
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Affiliation(s)
- B Sadeghi
- Surgical Department, Centre Hospitalo Universitaire (CHU) Lyon Sud, Lyon Pierre Bénite, France
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Sadeghi B, Arvieux C, Glehen O, Beaujard AC, Rivoire M, Baulieux J, Fontaumard E, Brachet A, Caillot JL, Faure JL, Porcheron J, Peix JL, François Y, Vignal J, Gilly FN. Peritoneal carcinomatosis from non-gynecologic malignancies: results of the EVOCAPE 1 multicentric prospective study. Cancer 2000. [PMID: 10640968 DOI: 10.1002/(sici)1097-0142(20000115)88:2<358::aid-cncr16>3.0.co;2-o] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Peritoneal carcinomatosis (PC) is a common evolution of digestive cancer, associated with a poor prognosis. Yet it is poorly documented in the literature. METHODS Three hundred seventy patients with PC from non-gynecologic malignancies were followed prospectively: the PC was of gastric origin in 125 cases, of colorectal origin in 118 cases, of pancreatic origin in 58 cases, of unknown origin in 43 cases, and of miscellaneous origins in 26 cases. A previously reported PC staging system was used to classify these 370 patients. RESULTS Mean and median overall survival periods were 6.0 and 3.1 months, respectively. Survival rates were mainly affected by the initial PC stage (9.8 months for Stage I with malignant peritoneal granulations less than 5 mm in greatest dimension, versus 3.7 months for Stage IV with large, malignant peritoneal masses more than 2 cm in greatest dimension). The presence of ascites was associated with poor survival of patients with gastric or pancreatic carcinoma. Differentiation of the primary tumor did not influence the prognoses of patients with PC. CONCLUSIONS A better knowledge of the natural history of PC is needed, in view of the many Phase I, II, and III trials currently being conducted to evaluate aggressive multimodal therapeutic approaches to treating patients with PC from non-gynecologic malignancies.
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Affiliation(s)
- B Sadeghi
- Surgical Department, Centre Hospitalo Universitaire (CHU) Lyon Sud, Lyon Pierre Bénite, France
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Abstract
Ileal-pouch anal anastomosis is sometimes performed inappropriately in Crohn's disease patients. The aim of this study was to evaluate long-term results in this subset. In 54 ileal-pouch anal anastomoses performed between 1985 and 1997 for CUD the patient was eventually diagnosed as having Crohn's disease in seven cases. A retrospective review was performed. Definitive diagnosis was established on histopathology, endoscopy, and clinical presentation. The principal outcome factors were pouch failure, reason for failure, and functional results in cases of retained pouch. Patients ranked their quality of life between 1 and 10. We found three failures due to pelvic abscess, anoperineal disease, and anovulvar fistula. The pouch was excised in the latter patient; four patients retained their pouch. Functional results were good in the four (7 year follow-up): 7.25 bowel movements per day, ability to discriminate flatus from feces in three, soiling in one, urgency in one, perianal pad in one, ability to differ bowel movement for 66 min, diet, and antidiarrheal medication all four, pouchitis in one, sexual troubles in one woman, no urinary or obstetric trouble. Quality of life was judged satisfactory by six of the seven patients. Our 13% rate of inadvertent ileal-pouch anal anastomosis is higher than results usually reported. This difference is explained by the diagnostic criteria, whose validity is controversial. Three-stage surgery to decrease inadvertent restorative coloproctectomy is worth considering. Even if results are good when the pouch is functioning, Crohn's disease remains a contraindication to ileal-pouch anal anastomosis because of its high rate of failure and excision.
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Affiliation(s)
- V Peyrègne
- Department of General and Thoracic Surgery, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
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Abstract
STUDY AIM The aim of this retrospective study was to report a series of 12 carcinomas of the gallbladder diagnosed on the histological examination of specimens after cholecystectomy. PATIENTS AND METHODS From 1986 to 1996, 784 cholecystectomies were performed in the same center and 12 unexpected carcinomas of the gallbladder were histologically diagnosed (11 adenocarcinomas and one epidermoid carcinoma; one pT1, five pT2 and six pT3). There were nine women and three men (mean age: 72 years) with symptoms in relation with lithiasis. Complementary treatments were: intraoperative radiation therapy (IRT) plus external beam radiation therapy (ERT) in two cases (one pT1 and one pT2), surgery for a 2 cm deep excision of the liver bed plus lymph node dissection plus IRT and ERT in three cases (three pT3), ERT plus chemotherapy in one case (one pT3), no complementary treatment in six cases (four pT2 and two pT3). RESULTS One patient died on day 30 from acute respiratory failure. There was no morbidity. One patient died at 7 months from intercurrent disease. The mean survival rate for patients with pT1 and pT2 tumors was 45 months (with two recurrences at 1 year and 3 years) and for patients with pT3 tumors, 6.7 months. CONCLUSION Unexpected carcinomas of the gallbladder were recognized in 1.5% of specimens after cholecystectomy for lithiasis. In pT1 tumors, a simple cholecystectomy is sufficient. In pT2 and pT3, a liver resection with lymph node dissection is required, eventually associated with radiation therapy. Laparoscopic cholecystectomy is contraindicated in case of pre- or peroperative suspicion of a gallbladder carcinoma because of the risk of port site recurrences.
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Affiliation(s)
- O Glehen
- Laboratoire de recherche hyperthermie oncologie, UFR médecine Lyon Sud, Pierre-Bénite, France
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Sadeghi B, Arvieux C, Glehen O, Beaujard AC, Rivoire M, Baulieux J, Fontaumard E, Brachet A, Caillot JL, Faure JL, Porcheron J, Peix JL, François Y, Vignal J, Gilly FN. Peritoneal carcinomatosis from non-gynecologic malignancies: results of the EVOCAPE 1 multicentric prospective study. Cancer 2000; 88:358-63. [PMID: 10640968 DOI: 10.1002/(sici)1097-0142(20000115)88:2<358::aid-cncr16>3.0.co;2-o] [Citation(s) in RCA: 848] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Peritoneal carcinomatosis (PC) is a common evolution of digestive cancer, associated with a poor prognosis. Yet it is poorly documented in the literature. METHODS Three hundred seventy patients with PC from non-gynecologic malignancies were followed prospectively: the PC was of gastric origin in 125 cases, of colorectal origin in 118 cases, of pancreatic origin in 58 cases, of unknown origin in 43 cases, and of miscellaneous origins in 26 cases. A previously reported PC staging system was used to classify these 370 patients. RESULTS Mean and median overall survival periods were 6.0 and 3.1 months, respectively. Survival rates were mainly affected by the initial PC stage (9.8 months for Stage I with malignant peritoneal granulations less than 5 mm in greatest dimension, versus 3.7 months for Stage IV with large, malignant peritoneal masses more than 2 cm in greatest dimension). The presence of ascites was associated with poor survival of patients with gastric or pancreatic carcinoma. Differentiation of the primary tumor did not influence the prognoses of patients with PC. CONCLUSIONS A better knowledge of the natural history of PC is needed, in view of the many Phase I, II, and III trials currently being conducted to evaluate aggressive multimodal therapeutic approaches to treating patients with PC from non-gynecologic malignancies.
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Affiliation(s)
- B Sadeghi
- Surgical Department, Centre Hospitalo Universitaire (CHU) Lyon Sud, Lyon Pierre Bénite, France
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