Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in seven patients with peritoneal sarcomatosis from uterine sarcoma

Abstract

Key Clinical MessagePeritoneal sarcomatosis from uterine sarcoma is a rare disease with no effective treatment and poor prognosis. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) has successful results in peritoneal carcinomatosis from gastrointestinal/gynecological origins. We show that CRS/HIPEC is safe, feasible, and may benefit selected patients with peritoneal sarcomatosis from uterine sarcoma.

Long-term outcomes after cytoreductive surgery and HIPEC for morcellated uterine leiomyosarcoma; A case series

“…There is emerging evidence to support HIPEC as a treatment option for epithelial ovarian cancer, however data to support HIPEC for uLMS is still anecdotal due to the rarity of disease ( van Driel et al, 2018 , Zivanovic et al, 2015 ). Sardi et al reported that among 7 primary or recurrent uterine sarcoma patients, 3-year PFS was 38.7%, and 5-year OS was 57.1% after cytoreductive surgery and HIPEC therapy ( Sardi et al, 2018 ). Sardi et al also conducted a retrospective review of 36 patients from multiple international centers where HIPEC therapy was used and reported 5-year PFS was 32% and 5-year OS was 32% among patients who had complete cytoreduction plus HIPEC ( Sardi et al, 2017 ).…”

Hyperthermic intraperitoneal chemotherapy (HIPEC) for gynecological cancer

“…The appropriate concentration of melphalan for safety without grade 4 morbidity and good pharmacokinetics was reported to be 60 mg/m 2 37 . The effectiveness of melphalan has been reported in a few studies, 4,28,31 and it seems to have similar efficacy to doxorubicin. There have been no comparative studies of doxorubicin and melphalan to evaluate their efficacy and safety for uterine sarcomatosis because of the rarity of the disease.…”

“…The studies of HIPEC in uterine sarcomatosis are summarized in Table 2 4,25–33 . Cisplatin (CDDP) has been used for many cases even with uterine sarcomatosis as the chemotherapeutic agent of HIPEC because CDDP is one of the most effective and proven chemotherapeutic agents for HIPEC for carcinomatous peritonitis, as we have already mentioned.…”

Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) in peritoneal sarcomatosis—A systematic review and meta-analysis

“…A total of 309 articles were identified from 3 electronic database searches, including 4 additional records from the review of reference lists and correspondence with field experts (Figure 1). After the removal of duplicates, initial title and abstract screening, followed by further evaluation of full texts, 20 articles published between 2004 and 2019 were eligible for final inclusion in the qualitative synthesis (Table 1) [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]. 18 articles further provided sufficient statistical information for meta-analysis, although Goéré et al ( 2017) was excluded due to potential overlap in subjects with other studies and Bryan et al (2014) was excluded as the primary histology was that of gastrointestinal stromal tumors (GIST), leaving 16 articles for quantitative synthesis [16-18, 20, 23, 24, 26-35].…”

“…In addition to the histopathologic and radiologic diagnosis of PS, many studies specified additional eligibility criteria for CRS-HIPEC, including age, performance status, possibility of complete cytoreduction based on pre-operative imaging, absence of significant comorbidities and extra-abdominal/hepatic metastases, as well as satisfactory hepatic, renal, and bone marrow function. The extent of PS was quantified intra-operatively using the PCI in 13 studies [16, 17,21,23,25,27,[29][30][31][32][33][34][35], the Dutch simplified peritoneal cancer index (SPCI) in 1 study [18], by noting tumor size and number of nodules resected in 1 study [26], and not specified in 5 studies [19,20,22,24,28]. The degree of resection was quantified using the CC score in 16 studies [16-18, 20, 21, 23, 24, 26, 27, 29-35], and the residual tumor (R) classification in 4 studies [19,22,25,28].…”