Extensive surgical cytoreduction and intraoperative hyperthermic intraperitoneal chemotherapy in patients with pseudomyxoma peritonei

Witkamp, Arjen J.; Bree, Eelco de; Kaag, M.; Slooten, Gooike W. van; Coevorden, Frits van; Zoetmulder, F.A.N.

doi:10.1046/j.1365-2168.2001.01701.x

Cited by 154 publications

(82 citation statements)

References 23 publications

(19 reference statements)

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“…However, a recent report described a patient with PMP responding to capecitabine -an oral fluoropyrimidine (Levitz et al, 2004). Given this, and the following rationales: (i) mitomycin C (MMC) and 5-fluorouracil (5-FU) are administered as HIPEC in the management of PMP (Witkamp et al, 2001;Sugarbaker, 2006); (ii) MMC is an established antitumour agent against gastrointestinal cancers (Crooke and Bradner, 1976;Ozawa et al, 1988); and (iii) oral capecitabine has equivalence effectiveness to bolus intravenous 5-FU/folinic acid in the treatment of metastatic colorectal cancer (Hoff et al, 2001;Van Cutsem et al, 2001), but with better patient acceptance (Borner et al, 2002), we hypothesized that a combination of concurrent MMC and capecitabine (MCap) would benefit patients with advanced PMP. Furthermore, this regimen is effective in advanced colorectal cancer (Rao et al, 2004).…”

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confidence: 99%

A phase II study evaluating the use of concurrent mitomycin C and capecitabine in patients with advanced unresectable pseudomyxoma peritonei

et al. 2008

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Pseudomyxoma peritonei (PMP) is a rare neoplastic process characterised by progressive intra-abdominal dissemination of mucinous tumour, and generally considered resistant to systemic chemotherapy. A phase II study in patients with advanced unresectable PMP was undertaken to evaluate the combination of systemic concurrent mitomycin C (7 mg m À2 i.v. on day 1) and capecitabine (1250 mg m À2 b.d. on days 1 -14) in a 3-weekly cycle (MCap). Response was determined by semiquantitative assessment of disease volume on serial computed tomographic (CT) scans and serum tumour marker (CEA, CA125, CA19-9) changes at 12 weeks. Between 2003 and 2006, 40 patients were recruited through a national centre for the treatment of peritoneal surface tumours. At baseline, 23 patients had progressive disease and 17 had stable disease. Of 39 assessable patients, 15 (38%, 95% confidence intervals (CIs): 25, 54%) benefited from chemotherapy in the form of either reductions in mucinous deposition or stabilisation of progressive pretreatment disease determined on CT scan. Notably, two patients, originally considered unresectable, following MCap and re-staging underwent potentially curative cytoreductive surgery. Grade 3/4 toxicity rates were low (6%, 95% CIs: 4, 9%). Twenty out of 29 assessed patients (69%, 95% CIs: 51, 83%) felt that their Global Health Status improved during chemotherapy. This is the first trial to demonstrate an apparent benefit of systemic chemotherapy in patients with advanced unresectable PMP.

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confidence: 99%

A phase II study evaluating the use of concurrent mitomycin C and capecitabine in patients with advanced unresectable pseudomyxoma peritonei

et al. 2008

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“…Two studies 10,11 did not report whether patients entering the study were at a similar point in their disease progression, while three studies 6,12,13 were unclear. Four studies 6,10,12,13 were judged unclear on follow-up length and one study 11 did not report follow-up length. All five studies 6,10-13 were judged to be unclear when reporting whether outcomes were assessed objectively or blinding was used.…”

Section: Quality Quantity and Characteristics Of Research Availablementioning

confidence: 99%

“…Five retrospective case series reports 6,[10][11][12][13] concerning the Sugarbaker procedure met the inclusion criteria for the systematic review and are shown in Appendix 7 and Table 2. No studies examining standard debulking surgery met the inclusion criteria for the systematic review.…”

Section: Quality Quantity and Characteristics Of Research Availablementioning

confidence: 99%

Clinical effectiveness and costs of the Sugarbaker procedure for the treatment of pseudomyxoma peritonei

Bryant

Clegg²,

Sidhu³

et al. 2004

Health Technol Assess

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“…These extensive treatments have been developed in order to remove all macroscopic lesions to enhance the efficacy of HIPEC. This aggressive treatment achieved the long term survival for selected diseases, such as pseudomyxoma peritonei and some colorectal cancers [68,69]. However, the combination of peritonectomy and HIPEC can lead to greater mortality and morbidity rates.…”

Section: Intraoperative Chemotherapy For Peritoneal Carcinomatosismentioning

confidence: 99%

Intraperitoneal Chemotherapy as a Multimodal Treatment for Gastric Cancer Patients with Peritoneal Metastasis

Fushida¹,

Oyama²,

Koyama³

et al. 2013

JCT

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Peritoneal metastasis of gastric cancer is mainly caused by the dispersion of free cancer cells from the serosal surface of the invaded stomach, from surgically transected lymphatic channels, and from tumor cell-containing blood from the primary lesion into the peritoneal cavity. Intraperitoneal chemotherapy (IPC) combined with surgery has performed for the prevention and treatment of peritoneal metastasis in gastric cancer. The efficacy of this technique is influenced by the pharmacokinetic advantage achievable with the anticancer drug, timing of administration, combination with hyperthermia, and tumor volume. The pharmacokinetic advantage for peritoneal cavity exposure relative to peripheral circulation by intraperitoneal delivery for drugs including cisplatin (10-fold advantage), mitomycin C (20-to 30-fold advantage), docetaxel (500-fold advantage), and paclitaxel (1000-fold advantage) has been confirmed. To avoid uneven drug distribution in the peritoneal cavity and the re-growth of residual tumor, it seems to be reasonable to perform IPC perioperatively; however, early perioperative intraperitoneal chemotherapy (EPIC) has a relatively high morbidity rate compared with intraoperative IPC. Hyperthermia has both cytotoxicity of itself and a synergistic effect with anticancer drugs, especially mitomycin C. In the adjuvant setting, patients with either hyperthermic intraperitoneal chemotherapy (HIPEC) or EPIC showed a significant improvement of survival compared to those with surgery alone. In addition, extensive intraoperative peritoneal lavage (EIPL) seems also to be a reasonable method to reduce free cancer cells in the peritoneal cavity. For the treatment of peritoneal metastasis, cytoreductive surgery which achieves R0 or R1 resection followed by IPC has demonstrated a survival benefit, whereas gross residual tumor (R2) treated by IPC has shown poor prognosis. Extensive cytoreductive surgery, such as peritonectomy, followed by IPC achieved long-term survival for selected patients, though this aggressive procedure led to high morbidity and mortality rates. It seems that combined chemotherapy (systemically and intraperitoneally) followed by conversion surgery can be expected to be a powerful procedure for the patients with gross peritoneal tumors.

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Extensive surgical cytoreduction and intraoperative hyperthermic intraperitoneal chemotherapy in patients with pseudomyxoma peritonei

Abstract: These results confirm that extensive surgery combined with HIPEC is feasible in patients with pseudomyxoma peritonei and that improved long-term survival might be achieved.

Cited by 154 publications

References 23 publications

A phase II study evaluating the use of concurrent mitomycin C and capecitabine in patients with advanced unresectable pseudomyxoma peritonei

A phase II study evaluating the use of concurrent mitomycin C and capecitabine in patients with advanced unresectable pseudomyxoma peritonei

Clinical effectiveness and costs of the Sugarbaker procedure for the treatment of pseudomyxoma peritonei

Intraperitoneal Chemotherapy as a Multimodal Treatment for Gastric Cancer Patients with Peritoneal Metastasis

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