Cytoreductive surgery with hyperthermic intraperitoneal chemoperfusion (HIPEC): Toxicity, survival, and prognostic variables in 130 patients with peritoneal carcinomatosis

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 15040-15040
Author(s):  
W. Ceelen ◽  
M. Peeters ◽  
P. Houtmeyers ◽  
C. Breusegem ◽  
F. De Somer ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Ovarian Cancer ◽  
Overall Survival ◽  
Peritoneal Carcinomatosis ◽  
Cytoreductive Surgery ◽  
Systemic Chemotherapy ◽  
Residual Disease ◽  
Univariate Analysis ◽  
Dismal Prognosis ◽  
Extent Of Disease

15040 Background: Peritoneal carcinomatosis (PC) has a dismal prognosis. Cytoreductive surgery with HIPEC has been introduced in the management of PC with biologically favourable features. Methods: In an eight year period, 130 patients were treated (53% female, mean age 56±1 years). The origin of PC was colorectal cancer (CRC, 58%), pseudomyxoma peritonei (PMP, 9%), ovarian cancer (17%), primary peritoneal mesothelioma (10%) and gastric cancer (6%). Surgery was followed by HIPEC with mitomycin C (90 min, 35 mg/m2), oxaliplatin (30 min, 460 mg/m2) or cisplatin (90 min, 100–250 mg /m2) depending on tumour histology and previous systemic chemotherapy. The extent of disease was scored using a scale ranging from 0–9, while completeness of cytoreduction (CC) was scored as complete (CC0), nearly complete (CC1, miliary residual disease) or incomplete (CC2, gross residual disease). Target intraperitoneal temperature was 41°C-42°C. Actuarial survival was calculated using the Kaplan Meier method and univariate analysis performed using the log rank method. Results: Open perfusion (coliseum technique) was used in 41% of procedures. Macroscopically complete resection was achieved in 41%. Postoperative 30 day mortality was 1.5% while major morbidity developed in 18% of patients. Morbidity was mainly related to the extent of surgery. Median overall survival (months) was as follows: CRC, 20; PMP, 38; ovarian cancer, 19; gastric cancer, 10; mesothelioma, 9. Median survival was significantly better in CC0 patients (40 months) compared to CC1 (17 months) or CC2 (12 months). Survival was significantly worse in patients with ascites at surgery (p<0.02) and in patients who did not receive adjuvant systemic chemotherapy (p<0.001). The extent of disease score before surgery (p=0.29), performance of a splenectomy (p=0.65), and timing of PC (metachronous or synchronous, p=0.25) were not significantly related to overall survival. Conclusions: Cytoreduction followed by HIPEC offers a significant survival advantage in selected patients with PC with acceptable early toxicity. Survival is significantly associated with disease histology, CC, presence of ascites and adjuvant chemotherapy. No significant financial relationships to disclose.

scholarly journals Survival outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis from gastric cancer: a systematic review

2016 ◽  
Vol 1 (2) ◽  
pp. 67-77 ◽  
Author(s):  
Claramae Shulyn Chia ◽  
Ramakrishnan Ayloor Seshadri ◽  
Vahan Kepenekian ◽  
Delphine Vaudoyer ◽  
Guillaume Passot ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Peritoneal Carcinomatosis ◽  
Median Survival ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Current Evidence ◽  
Term Survival ◽  
Crs And Hipec

AbstractBackground: The current treatment of choice for peritoneal carcinomatosis from gastric cancer is systemic chemotherapy. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is a new aggressive form of loco-regional treatment that is currently being used in pseudomyxoma peritoneii, peritoneal mesothelioma and peritoneal carcinomatosis from colorectal cancer. It is still under investigation for its use in gastric cancer.Methods: The literature between 1970 and 2016 was surveyed systematically through a review of published studies on the treatment outcomes of CRS and HIPEC for peritoneal carcinomatosis from gastric cancer.Results: Seventeen studies were included in this review. The median survival for all patients ranged from 6.6 to 15.8 months. The 5-years overall survival ranged from 6 to 31%. For patients with complete cytoreduction, the median survival was 11.2 to 43.4 months and the 5-years overall survival was 13 % to 23%. Important prognostic factors were found to be a low peritoneal carcarcinomatosis index (PCI) score and the completeness of cytoreduction.Conclusion: The current evidence suggests that CRS and HIPEC has a role to play in the treatment of peritoneal carcinomatosis from gastric cancer. Long term survival has been shown for a select group of patients. However, further studies are needed to validate these results.

scholarly journals C-ERB-2, P53, Ki67 Proteins and Receptors of Estrogen and Progesterone on the Prognosis of Epithelial Ovarian Cancer

2019 ◽  
pp. 169-179
Author(s):  
Tomé A ◽  
Leal I ◽  
Palmeiras C ◽  
Matos E ◽  
Amado J ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Overall Survival ◽  
Survival Time ◽  
Residual Disease ◽  
Clinical Stage ◽  
Clinical Status ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Figo Stage ◽  
Positive Staining

Ovarian cancer is the seventh most common cancer diagnosed in women worldwide. To date, many studies inepithelial ovarian cancer (EOC) have reported on the association HER-2/neu, p53 proteins and steroid hormones and their respective receptors with prognosis and/or the carcinogenesis process, but no definitive conclusion has been reached.Objectives: To assess the proteins c-erbB-2, p53, Ki67 and receptors of estrogen (ER) and progesterone (PR) of EOC, with regard to clinical stage findings and its effect on survival.Methods: 125 patients with a diagnosis of EOC treated by primary surgery and chemotherapy have participated. A surgical stage was noted and analyzed the correlation with c-erbB-2, p53, Ki67, ER and PR. Immunohistochemical analysis, using the anti-c-erbB-2, p53, Ki67 monoclonal antibodies, the antibody cod PR clone PgR and code ER-6-F11 Anti human estrogen. The c-erbB-2 study was complemented by genetic amplification and was reported univariate and multivariate analysis.Results: Age 55.7 ± 16; 50.2% with residual disease (< 2 cm); initial (54.6%) and advanced (45.4%) stage. Univariate analysis showed positive staining for c-erbB-2, p-53, Ki67, PR and ER. The patients with negative receptors had a significantly shortened survival time (p = 0.01) than patients with positive receptors. Multivariable analysis revealed only clinical FIGO stage as an independent prognostic of overall survival (p = 0.002). Other variables like c-erbB-2, p53, Ki67, and ER were not significantly related to survival.Conclusions: We concluded that patients with negative PR had a significantly shortened survival time than patients with positive receptors. The overexpression of markers c-erbB-2, p53, Ki67, and ER, were not significantly related to survival in EOC. Only the FIGO stage was achieved to be an independent predictor of overall survival. They should be evaluated together with the patient’s clinical status and other prognostic factors.

scholarly journals Primary cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy (HIPEC) for FIGO stage III epithelial ovarian cancer: OVHIPEC-2, a phase III randomized clinical trial

2020 ◽  
Vol 30 (6) ◽  
pp. 888-892 ◽  
Author(s):  
Simone Koole ◽  
Ruby van Stein ◽  
Karolina Sikorska ◽  
Desmond Barton ◽  
Lewis Perrin ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Overall Survival ◽  
Epithelial Ovarian Cancer ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Residual Disease ◽  
Figo Stage ◽  
Primary Objective ◽  
Phase Iii ◽  
Stage Iii

BackgroundThe addition of hyperthermic intraperitoneal chemotherapy (HIPEC) to interval cytoreductive surgery improves recurrence-free and overall survival in patients with FIGO stage III ovarian cancer who are ineligible for primary cytoreductive surgery. The effect of HIPEC remains undetermined in patients who are candidates for primary cytoreductive surgery.Primary objectiveThe primary objective is to evaluate the effect of HIPEC on overall survival in patients with FIGO stage III epithelial ovarian cancer who are treated with primary cytoreductive surgery resulting in no residual disease, or residual disease up to 2.5 mm in maximum dimension.Study hypothesisWe hypothesize that the addition of HIPEC to primary cytoreductive surgery improves overall survival in patients with primary FIGO stage III epithelial ovarian cancer.Trial designThis international, randomized, open-label, phase III trial will enroll 538 patients with newly diagnosed FIGO stage III epithelial ovarian cancer. Following complete or near-complete (residual disease ≤2.5 mm) primary cytoreduction, patients are randomly allocated (1:1) to receive HIPEC or no HIPEC. All patients will receive six courses of platinum-paclitaxel chemotherapy, and maintenance PARP-inhibitor or bevacizumab according to current guidelines.Major eligibility criteriaPatients with FIGO stage III primary epithelial ovarian, fallopian tube, or primary peritoneal cancer are eligible after complete or near-complete primary cytoreductive surgery. Patients with resectable umbilical, spleen, or local bowel lesions may be included. Enlarged extra-abdominal lymph nodes should be negative on FDG-PET or fine-needle aspiration/biopsy.Primary endpointThe primary endpoint is overall survival.Sample sizeTo detect a HR of 0.67 in favor of HIPEC, 200 overall survival events are required. With an expected accrual period of 60 months and 12 months additional follow-up, 538 patients need to be randomized.Estimated dates for completing accrual and presenting resultsThe OVHIPEC-2 trial started in January 2020 and primary analyses are anticipated in 2026.Trial registrationClinicalTrials.gov:NCT03772028

Peritoneal adenocarcinoma (serous) of Müllerian type: a subgroup of women presenting with peritoneal carcinomatosis

1994 ◽  
Vol 4 (1) ◽  
pp. 43-51 ◽  
Author(s):  
J. M. Fowler ◽  
R. K. Nieberg ◽  
T. A. Schooler ◽  
J. S. Berek
Keyword(s):  
Ovarian Cancer ◽  
Peritoneal Carcinomatosis ◽  
Cytoreductive Surgery ◽  
Preoperative Diagnosis ◽  
Residual Disease ◽  
Statistical Significance ◽  
Serous Carcinoma ◽  
Term Survival ◽  
Primary Surgery ◽  
Initial Surgery

Peritoneal adenocarcinoma (serous or other subtype) of Müllerian type (PAMT) is frequently misclassified as another primary tumor. Peritoneal carcinomatosis in women without evidence of a primary site may occur secondary to a number of processes. Confusion regarding the nomenclature has made it difficult to determine the incidence and natural history of this unique malignancy. Other terms used for this tumor include mesothelioma, peritoneal papillary serous carcinoma, extra-ovarian serous carcinoma, and normal-sized ovarian carcinoma syndrome. Thirty-four patients (33 serous and one endometrioid) were identified with PAMT during 1976 through 1988. One hundred and thirty-seven patients underwent primary cytoreductive surgery for a preoperative diagnosis consistent with ovarian cancer. Twenty-nine (21.2%) were classified as PAMT (5 of the 34 had their initial surgery at other institutions). The mean age was 61.4 years. The primary symptoms and signs were abdominal pain (68%) and ascites (52%). Twenty-five (73%) had a preoperative diagnosis of ovarian cancer while the postoperative diagnosis was unknown (44%), PAMT (29%), and ovarian cancer (27%). Univariate and multivariate survival analysis were performed. Survival was independent of age, residual disease, grade, ascites, type of chemotherapy, and second-look results. In patients with residual disease < 1.5 cm, extended survival was found in (hose with ascites < 1000 ml, residual disease in pelvis only, and small residual volume but statistical significance was not obtained. Twenty-eight patients received ≥4 courses of chemotherapy after primary surgery. Twelve of 21 patients (57%) who received cisplatin (CDDP) survived between 23 and 92 months, while no patient receiving other chemotherapeutic regimens survived more than 25 months. The 2 and 3 year survival rate for CDDP was 47% and 33% vs. 14% and 0% for other regimens. Optimal cytoreductive surgery was not an independent prognostic factor as found in ovarian cancer, probably secondary to unresectable peritoneal carcinomatosis. PAMT is sensitive to chemotherapy but only the use of CDDP was associated with long term survival. Based on these results, women with peritoneal carcinomatosis consistent with PAMT should receive a CDDP-based regimen after primary surgery.

scholarly journals Gastric cancer: modern approaches and prospects of treatment for peritoneal carcinomatosis (literature review)

2022 ◽  
Vol 20 (6) ◽  
pp. 104-113
Author(s):  
V. A. Markovich ◽  
S. A. Tuzikov ◽  
E. O. Rodionov ◽  
N. V. Litvyakov ◽  
N. O. Popova ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Peritoneal Carcinomatosis ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Systemic Chemotherapy ◽  
Antitumor Agents ◽  
Peritoneal Cancer Index ◽  
Abdominal Cavity ◽  
Cochrane Library

Gastric cancer (gc) is one of the most common cancers worldwide. The majority of newly diagnosed gastric cancer cases present with distant metastases. Peritoneal carcinomatosis (pc) is the most unfavorable type of progression of primary gc, which occurs in 14–43 % of patients. The purpose of the study was to highlight modern approaches to the treatment of gc with pc. Material and methods. We analyzed 136 publications available from pubmed, medline, cochrane library, and elibrary databases. The final analysis included 46 studies that met the specified parameters. Results. The modern approaches to the treatment of gc with peritoneal carcinomatosis were reviewed, namely: cytoreductive surgery (crs), combination of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (crs/hipec); neoadjuvant intraperitoneal/systemic chemotherapy (nips) and pressurized intraperitoneal aerosol chemotherapy (pipac). The results of large randomized trials and meta-analyses were analyzed. Benefits and limitations of these trials were assessed. Conclusion. The peritoneal cancer index (pci) and the level of cytoreduction are two key prognostic factors for increasing the median overall survival. By reducing tumor volume through cytoreductive surgery, it is possible to allow tumor cells to re-enter the proliferative phase of the cell cycle and make them more sensitive to antitumor agents. The hematoperitoneal barrier is the main reason that prevents the effective delivery of drugs from the systemic bloodstream to the abdominal cavity, which is why the effect of systemic chemotherapy on peritoneal metastases is extremely limited. Intraperitoneal chemotherapy offers a more effective and intensive regional therapy, creating a so-called «depot» of a chemotherapy drug, thereby prolonging the effect of the administered drugs. Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (crs + hipec) using the combination of surgical resection, cytotoxic chemotherapy, hyperthermic ablation of the tumor and hydrodynamic flushing, is a promising approach in the treatment of gc with peritoneal carcinomatosis.

scholarly journals Treatment of peritoneal surface neoplasms with intraperitoneal chemotherapy in hyperthermia

2015 ◽  
Vol 125 (1) ◽  
pp. 20-23
Author(s):  
Jerzy Mielko ◽  
Bogumila Ciaseł ◽  
Magdalena Skórzewska ◽  
Robert Sitarz ◽  
Andrzej Kurylcio ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Gastric Cancer ◽  
Ovarian Cancer ◽  
Metastatic Colorectal Cancer ◽  
Peritoneal Carcinomatosis ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Research Group ◽  
Secondary Neoplasms ◽  
Peritoneal Surface

Abstract Effective treatment of peritoneal surface neoplasms is possible through the simultaneous use of cytoreductive surgery with intraperitoneal chemotherapy in hyperthermia. It is successfully performed in patients with peritoneal pseudomyxoma, mesothelioma, as well as a limited and resectable peritoneal carcinomatosis in the course of colorectal cancer. It can also be used in patients with gastric or ovarian cancer but also metastatic colorectal cancer or metastases to the ovaries from gastric cancer. Aggressive surgical management of patients with primary or secondary neoplasms of the peritoneal surface was initiated by Sugarbaker’s research group.

Prognostic significance of residual disease in advanced stage malignant ovarian germ cell tumors

2019 ◽  
Vol 29 (3) ◽  
pp. 554-559 ◽  
Author(s):  
Dimitrios Nasioudis ◽  
Eloise Chapman-Davis ◽  
Melissa K Frey ◽  
Thomas A Caputo ◽  
Steven S Witkin ◽  
...  
Keyword(s):  
Overall Survival ◽  
Germ Cell ◽  
Cytoreductive Surgery ◽  
Residual Disease ◽  
Univariate Analysis ◽  
Prognostic Significance ◽  
Germ Cell Tumors ◽  
Rank Test ◽  
Advanced Stage ◽  
Cancer Data

ObjectiveTo investigate the prognostic significance of complete gross resection following cytoreductive surgery for patients with advanced stage malignant ovarian germ cell tumors.MethodsThe National Cancer Data Base was accessed and patients diagnosed with an advanced stage (II-IV) malignant ovarian germ cell tumor who underwent primary cytoreductive surgery between 2011 and 2014 were selected for further analysis. For analysis purposes two groups were formed: patients with complete gross resection and those with macroscopic residual disease. Demographic and clinico-pathological characteristics were compared with the chi-square and Mann–Whitney U test. Univariate survival analysis was performed with the log-rank test after generation of Kaplan–Meier curves, while a Cox proportional hazard model was constructed to evaluate mortality after controlling for confounders.ResultsA total of 343 patients who met the inclusion criteria were identified. Residual disease status was available for 276 patients: the rate of complete gross resection was 69.2 %. By univariate analysis there was no difference in overall survival between patients in the complete gross resection and macroscopic residual disease groups, P= 0.26; 3-year overall survival rates: 86.4 % and 82.8 %, respectively. No difference in overall survival was noted following stratification by histology; P = 0.64 and P = 0.24 for dysgerminoma and non-dysgerminoma tumor groups. After controlling for stage IV disease, histology and the administration of chemotherapy, macroscopic residual disease was not associated with a worse mortality (HR: 1.22, 95% CI: 0.61 to 2.46).ConclusionsMacroscopic residual disease following primary cancer-directed surgery was not associated with a worse prognosis in a cohort of patients with advanced stage malignant ovarian germ cell tumors.

scholarly journals Microscopic Peritoneal Residual Disease after Complete Macroscopic Cytoreductive Surgery for Advanced High Grade Serous Ovarian Cancer

2020 ◽  
Vol 10 (1) ◽  
pp. 41
Author(s):  
Henri Azaïs ◽  
Anne-Sophie Vignion-Dewalle ◽  
Marine Carrier ◽  
Jeremy Augustin ◽  
Elisabeth Da Maïa ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Cytoreductive Surgery ◽  
Systemic Chemotherapy ◽  
Residual Disease ◽  
Peritoneal Metastases ◽  
High Grade ◽  
Serous Ovarian Cancer ◽  
Conventional Surgery ◽  
Ovarian Cancers ◽  
A Prospective Study

Background: Epithelial ovarian cancers (EOC) are usually diagnosed at an advanced stage and managed by complete macroscopic cytoreductive surgery (CRS) and systemic chemotherapy. Peritoneal recurrence occurs in 60% of patients and may be due to microscopic peritoneal metastases (mPM) which are neither eradicated by surgery nor controlled by systemic chemotherapy. The aim of this study was to assess and quantify the prevalence of residual mPM after complete macroscopic CRS in patients with advanced high-grade serous ovarian cancer (HGSOC). Methods: A prospective study conducted between 1 June 2018 and 10 July 2019 in a single referent center accredited by the European Society of Gynecological Oncology for advanced EOC management. Consecutive patients presenting with advanced HGSOC and eligible for complete macroscopic CRS were included. Up to 13 peritoneal biopsies were taken from macroscopically healthy peritoneum at the end of CRS and examined for the presence of mPM. A mathematical model was designed to determine the probability of presenting at least one mPM after CRS. Results: 26 patients were included and 26.9% presented mPM. There were no differences in characteristics between patients with or without identified mPM. After mathematical analysis, the probability that mPM remained after complete macroscopic CRS in patients with EOC was 98.14%. Conclusion: Microscopic PM is systematically present after complete macroscopic CRS for EOC and could be a relevant therapeutic target. Adjuvant locoregional strategies to conventional surgery may improve survival by achieving microscopic CRS.

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