scholarly journals Comparison of Peritoneal Carcinomatosis Scoring Methods in Predicting Resectability and Prognosis in Gynecologic Malignancies

2021 ◽  
Vol 10 (12) ◽  
pp. 2553
Author(s):  
María Teresa Climent ◽  
Anna Serra ◽  
Juan Gilabert-Estellés ◽  
Juan Gilabert-Aguilar ◽  
Antoni Llueca
Keyword(s):  
Peritoneal Carcinomatosis ◽  
Peritoneal Cancer Index ◽  
Neoadjuvant Treatment ◽  
Scoring Methods ◽  
Surgical Team ◽  
Gynecologic Malignancies ◽  
Peritoneal Cancer ◽  
Advanced Stages ◽  
Best Parameter ◽  
Incomplete Surgery

Objective: Peritoneal carcinomatosis is a disease’s presentation in the advanced stages of many gynecologic tumours. The distribution and volume of the disease are the main factors in achieving complete debulking. Diagnostic laparoscopy is a technique to allow evaluation of the disease. This study’s objective is to compare two laparoscopic scores (Fagotti’s index and Sugarbaker’s peritoneal cancer index (PCI)) and assess the diagnostic accuracy to select patients for neoadjuvant treatment and reduce unnecessary laparotomies. Methods: A non-randomised retrospective cohort study was conducted in patients with peritoneal carcinomatosis (ovarian and endometrial origin) who underwent laparoscopy and subsequent laparotomy. We evaluated the scores’ ability to predict incomplete surgery and whether they were related to the patients’ prognosis. Results: We included 34 patients, of which 23.5% received neoadjuvant chemotherapy. The rate of complete cytoreductive surgery was 79.4% (n = 27 patients). The highest sensitivity was obtained with a PCI value greater than 20. It was the best parameter to determine incomplete debulking. Survival curves were analysed according to the “cut off” established for each score, and statically significant differences were found using PCI with respect to Fagotti’s Index. However, these differences were not found with Fagotti’s score. Conclusion: The best diagnostic method to classify patients with peritoneal cancer is the PCI. It could be adapted to each surgical team because it allows identifying the “cut off point”, which depends on incomplete surgery rate.

Circulating tumor DNA as a prognostic factor in peritoneal carcinomatosis after hyperthermic intraperitoneal chemotherapy.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e16280-e16280
Author(s):  
Zongyuan Li ◽  
Xiaolin Pu ◽  
Hua Jiang
Keyword(s):  
Peritoneal Carcinomatosis ◽  
Tumor Markers ◽  
Intraperitoneal Chemotherapy ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Peritoneal Cancer Index ◽  
Circulating Tumor Dna ◽  
Plasma Samples ◽  
Peritoneal Cancer ◽  
Time Points ◽  
Tumor Dna

e16280 Background: Hyperthermic intraperitoneal chemotherapy (HIPEC) is the main treatment for peritoneal carcinomatosis (PC).However, It is still a major problem to predict the efficacy of HIPEC. Some studies have shown that peritoneal cancer index (PCI) can be used to predict the efficacy of HIPEC, but the invasiveness and inaccuracy are shortcomings. Therefore, we need a minimally invasive and accurate prediction biomarker. Many studies have confirmed that circulating tumor DNA (ctDNA) can accurately predict the efficacy and prognosis of various solid tumors. This study aimed to evaluate the predictive value of ctDNA from ascites and plasma for HIPEC. Methods: Eligible PC patients should be defintive diagnosed by pathology or cytology. Each patient was treated with HIPEC for 4 times, with an interval of 3 days each time. Plasma and ascites samples were collected before HIPEC and after the last HIPEC. All samples were detected by next generation sequencing (NGS). The molecular tumor burden index (mTBI) and main clone variant allele fraction (VAF) changes were used as the prediction indexes of efficacy. In addition, The changes of common tumor markers such as CEA during the same period were used as controls. Results: A total of 19 patients with PC were enrolled from November 2018 to January 2020. Firstly, the mTBI changes of 14 patients whom had plasma samples at two time points (baseline and postHIPEC)were analyzed. Among them, 3 patients had no gene mutation were detected in two time points. There were significant differences in mTBI before and after HIPEC in the remaining 11 patients (Wilcoxon， p = 0.026). the median Ascites progression free survival (PFS) was 3.35 months (95% CI: 2.34 – 5.13 months), and the median overall survival (OS) was 5.93 months (95% CI: 4.93 – 11.17 months). The mTBI decline was significantly positively correlated with ascites PFS (Spearman r = 0.673, p = 0.023) and moderately positively correlated with OS (Spearman r = 0.510, p = 0.109). The highest VAF in plasma samples was defined as the main clone mutation. The main clone VAF decline was moderately positively correlated with ascites PFS (Spearman r = 0.588, p = 0.057) and slightly positively correlated with OS (Spearman r = 0.386, p = 0.241). As the controls, We found that the common tumor markers decline was no correlated with ascites PFS(Spearman r = 0.091, p = 0.790) and OS (Spearman r = 0.287, p = 0.396). We further analyzed the correlation of VAF between ascites and plasma co-mutation genes in 12 patients. The VAF of co-mutated genes in plasma and ascites was positively correlated (Spearman r = 0.794, p = 0.001). Conclusions: Plasma ctDNA can be used as a biomarker for predicting the efficacy of HIPEC for peritoneal carcinomatosis, and its accuracy is significantly higher than comon tumor markers. However, a larger sample size study are needed to validate our results.

The Accuracy of The Clinical Peritoneal Cancer Index in Patients with Peritoneal Carcinomatosis of Colorectal Cancer

2020 ◽  
Vol 46 (2) ◽  
pp. e77
Author(s):  
Nadine De Boer ◽  
Alexandra Brandt-Kerkhof ◽  
Eva Madsen ◽  
Cornelis Verhoef ◽  
Jacobus Burger
Keyword(s):  
Colorectal Cancer ◽  
Peritoneal Carcinomatosis ◽  
Peritoneal Cancer Index ◽  
Peritoneal Cancer

Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in the Treatment of Peritoneal Carcinomatosis: Initial Experience in Oaxaca, Mexico

2012 ◽  
Vol 78 (9) ◽  
pp. 942-946 ◽  
Author(s):  
Rolando GarcÍA-Matus ◽  
Carlos Alberto HernÁNdez-HernÁNdez ◽  
Omar Leyva-GarcÍA ◽  
Sergio Vásquez-Ciriaco ◽  
Guillermo Flores-Ayala ◽  
...  
Keyword(s):  
Peritoneal Carcinomatosis ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Peritoneal Cancer Index ◽  
Recurrent Ovarian Cancer ◽  
Initial Experience ◽  
Peritoneal Cancer ◽  
Duration Of Surgery ◽  
Crs And Hipec

Peritoneal carcinomatosis (PC) has been traditionally considered a terminal disease with median survivals reported in the literature of 6 to 12 months. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) are playing an ever increasing role in the treatment of these patients. Excellent results have been achieved in well-selected patients but there is a very steep learning curve when starting a new program. A program for peritoneal surface malignancies in which patients with PC of gastrointestinal or gynecological origin were treated using multi-modality therapy with combinations of systemic therapy, cytoreductive surgery (CRS), and HIPEC was initiated in December 2007 at “Hospital Regional de Alta Especialidad de Oaxaca,” Mexico. We present the results of our initial experience. From December 2007 to February 2011, 26 patients were treated with CRS and HIPEC. There were 21 female patients. Most common indication (46%) was recurrent ovarian cancer. Mean duration of surgery was 260 minutes. Mean Peritoneal Cancer Index was 9. Twenty-three (88.5%) patients had a complete cytoreduction. Major morbidity and mortality rates were 19.5 and 3.8 per cent, respectively. Mean hospital stay was 8 days. At a mean follow-up of 20 months, median survival has not been reached. Rigorous preoperative workup, strict selection criteria, and mentoring from an experienced cytoreductive surgeon are mandatory and extremely important when starting a center for PC.

scholarly journals Cytoreductive Surgery and Heated Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis Secondary to Mucinous Adenocarcinoma of the Appendix

2015 ◽  
Vol 100 (1) ◽  
pp. 21-28 ◽  
Author(s):  
David S. Sparks ◽  
Bradley Morris ◽  
Wen Xu ◽  
Jessica Fulton ◽  
Victoria Atkinson ◽  
...  
Keyword(s):  
Peritoneal Carcinomatosis ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Peritoneal Cancer Index ◽  
Disease Free Survival ◽  
Effective Treatment Option ◽  
Peritoneal Cancer ◽  
Heated Intraperitoneal Chemotherapy ◽  
Retrospective Clinical Study ◽  
Grade 3

Abstract Cytoreductive surgery (CRS) followed by hyperthermic intraperitoneal chemotherapy (HIPEC) is a radical but effective treatment option for select peritoneal malignancies. We sought to determine our early experience with this method for peritoneal carcinomatosis secondary to mucinous adenocarcinomas of appendiceal origin. As such, we performed a retrospective clinical study of 30 consecutive patients undergoing CRS with planned HIPEC at the Princess Alexandra Hospital, between June 2009 to December 2012, with mucinous adenocarcinomas of the appendix. CRS was performed in 30 patients, 13 received HIPEC intraoperatively and 17 received early postoperative intra-peritoneal chemotherapy (EPIC) in addition. Mean age was 52.3 years and median hospital stay was 26 days (range 12–190 days). Peritoneal cancer index scores were 0–10 in 6.7% of patients, 11–20 in 20% of patients and >20 in 73.3% of patients. Complete cytoreduction was achieved overall in 21 patients. In total, 106 complications were observed in 28 patients. Ten were grade 3-A, five were grade 3-B and one grade-5 secondary to a fatal PE on day 97. In patients who received HIPEC, there was no difference in disease-free survival (P = 0.098) or overall survival (P = 0.645) between those who received EPIC versus those who did not. This study demonstrates that satisfactory outcomes with regards to morbidity and survival can be achieved with CRS and HIPEC, at a single-centre institution with growing expertise in the technique. Our results are comparable with outcomes previously described in the international literature.

Evaluation of the treatment of peritoneal carcinomatosis of colorectal cancer (CRC) with complete cytoreduction and hyperthermic intraperitoneal peroperative chemotherapy (HIPEC) with oxaliplatin: A Belgian multicenter prospective phase II clinical study

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 4101-4101
Author(s):  
D. Hompes ◽  
A. D’Hoore ◽  
E. Van Cutsem ◽  
W. Ceelen ◽  
M. Peeters ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Peritoneal Carcinomatosis ◽  
Peritoneal Cancer Index ◽  
Postoperative Mortality ◽  
Operation Time ◽  
Progression Free Survival ◽  
Significant Prognostic Factor ◽  
Term Survival ◽  
Abdominal Complications ◽  
Peritoneal Cancer

4101 Background: Up to 25% of patients with metastatic CRC present with peritoneal carcinomatosis (PC) as the only site of metastases. The concept of Complete Cytoreductive Surgery (CCRS) followed by Hyperthermia and Intraperitoneal Chemotherapy (HIPEC) was developed, aiming for locoregional disease control and long-term survival. Methods: This prospective multicentre registry included 48 patients (M/F ratio 17/31) with PC from CRC, who underwent CCRS and HIPEC with oxaliplatin(460mg/m2). In 72.9% of patients the primary tumor had been previously resected. Median PCI (peritoneal cancer index) was 11 [1–22], with a median of 6 [1–11] abdominal regions involved and a median lesion size score of 3 [1–3]. In 11 cases associated lymph nodes (63.6% mesenteric, 27.3% para-aortic) were resected. To obtain CCRS a median of 2 [2–6] organs needed to be resected, with anterior resection in 45.8%, total colectomy in 8.3% and small bowel resection in 12.5% of cases. A median of 1 [0–6] anastomosis was performed per patient, of which one third were low and 82.1% were performed after HIPEC. Eleven ileostomies and 5 colostomies were constructed. Results: Median operation time was 460min.[125–840], with a median blood loss of 475ml [2- 6000]. HIPEC posed few procedural problems. There was no postoperative mortality. Complication rate was 52.1%, with 18 intra- and 17 extra-abdominal complications. Anastomotic leakage occurred in 10.4% of patients, bleeding in 6.3% and prolonged ileus in 22.9%. Median hospital stay was 20 [5–65] days. Occurrence of intra-abdominal complications significantly affected hospital stay (p=0.0012), but no risk factors for occurrence of postoperative complications could be clearly identified. Median follow-up was 22.7 [3.2–55.7] months, with 91.7% 2-year overall survival. Progression-free survival at 2 years is 64.6%, with PC recurrence in 29.2% of patients and other metastatic disease in 25%. Multivariate analysis only retained the CEA-level as a significant prognostic factor (p=0.0065). Conclusions: CCRS followed by HIPEC for PC of colorectal origin is safe and has longer than expected PFS and OS. No significant financial relationships to disclose.

scholarly journals Comparative characteristics of models of advanced ovarian carcinoma after orthotopic and intraperitoneal transplantation of a syngeneic tumor

2021 ◽  
Vol 67 (2) ◽  
pp. 300-308
Author(s):  
Ярослав Муразов ◽  
Aleksandr Stukov ◽  
Anna Nyuganen ◽  
Anna Artem`eva
Keyword(s):  
Ovarian Carcinoma ◽  
Peritoneal Cancer Index ◽  
Mature Female ◽  
Operating Conditions ◽  
Rank Test ◽  
Peritoneal Cancer ◽  
Female Wistar Rats ◽  
Advanced Stages ◽  
Histological Characteristics ◽  
Characteristic Features

Aim. To reveal the characteristic features of tumor growth after orthotopic (OT) and intraperitoneal transplantation (IT) of high-grade syngeneic ovarian carcinoma. Material and methods. Twenty mature female Wistar rats were randomized into two groups of ten each. The first group – animals underwent OT of ovarian carcinoma (4,3×106 cells) under the membrane of the bursa of the left and right ovaries; the second group – animals underwent IT of the tumor (4,3×107 cells). The endpoints of the study included an assessment of the overall survival (OS) of rats in two groups, determination of the peritoneal cancer index (PCI) on autopsy, and ascites weight. Autopsy material was histologically assessed analysis by light microscopy after standard staining. Cytological examination of ascitic fluid was carried out. Results. Median OS was 29 days and 21 days in the OT and IT groups, respectively (log-rank test, P = 0.0276). Autopsy did not reveal significant differences in total PCI (12.6 vs 13.6 in the OT and IT groups, respectively) and ascites weight (78.0 g in the OT vs 65.8 g in the IT group). The method of transplantation did not affect the tumor grafting, histological characteristics, the nature of intraperitoneal spread and the ascites volume. It should be noted that there was a greater volume of tumor lesions in the organs of the reproductive system of rats (ovaries, uterus with horns, paragonadal fat pad) in the OT group. Conclusion. Both methods of transplantation allow to reproduce the advanced stages (III-IV stages) of epithelial ovarian carcinoma in women. OT requires more time and operating conditions. OT and IT can be used to solve various problems in fundamental and routine preclinical cancer research.

Sign in / Sign up

Export Citation Format

Share Document