Hyperthermic intraperitoneal intraoperative chemotherapy after cytoreductive surgery for the treatment of abdominal sarcomatosis

Abstract

BACKGROUND Abdominal sarcomatosis is a rare nosologic entity with a poor prognosis. After a Phase I study on cytoreductive surgery combined with hyperthermic intraperitoneal intraoperative chemotherapy (HIIC), the authors reported the results of the treatment of 60 patients using this novel multimodal approach. METHODS Twenty‐nine patients had multifocal primary disease and 31 patients had recurrent abdominal sarcoma. Tumor histology was represented by visceral (n = 26 [43%]) and retroperitoneal (n = 34 [57%]) sarcoma. All patients underwent cytoreductive surgery (with no or minimal residual disease) and 90‐minute HIIC with doxorubicin (15.25 mg/L of perfusate) and cisplatin (43 mg/L). The clinical outcome and the prognostic value of 11 clinicopathologic variables were analyzed. RESULTS No postoperative deaths occurred. The morbidity rate was 33% and the moderate to severe locoregional toxicity rate was 15%. The median time to local disease progression and the median overall survival were 22 months and 34 months, respectively. Using multivariate analysis, histologic grading and completeness of surgical cytoreduction predicted patient prognosis, indicating that both local progression‐free and overall survival were affected significantly by tumor aggressiveness and local disease control. CONCLUSIONS Although these results were encouraging, there was no definitive conclusion reached regarding the therapeutic activity of this locoregional treatment. In addition, the toxicity rate was substantial. In the absence of effective systemic agents, the therapeutic potential of cytoreductive surgery plus HIIC should be explored further in comparative trials. Cancer 2004. © 2004 American Cancer Society.

Combined Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy for the Treatment of Advanced Ovarian Cancer

“…For those patients that have undergone surgery in 2-5 abdominopelvic regions the score is 2 (PSS-2) and for those patients that have undergone surgery in > 5 abdominopelvic regions the score is 3 (PSS-3) (Jacquet & Sugarbaker, 1996). Prior surgical score is a significant prognostic indicator of survival in peritoneal sarcomatosis, appendiceal cancer, and peritoneal mesothelioma (Rossi et al, 2004;Jacquet & Sugarbaker, 1996;Sebbag et al, 2000). The significance of PSS has been questioned by other studies for pseudomyxoma peritonei and peritoneal mesothelioma Deraco et al, 2006;Miner et al, 2005;Baratti et al, 2007).…”

“…For low-grade tumors CC-0 and CC-1 cytoreductions are considered complete cytoreductive operations. The completeness of cytoreduction score is the most significant prognostic indicator of survival in patients with pseudomyxoma peritonei (Sugarbaker, 2006;Miner et al, 2005;Baratti et al, 2007) peritoneal mesothelioma (Yan et al 2007;Sebbag et al, 2000;Brigand et al, 2006;Deraco et al, 2006), colorectal cancer with peritoneal carcinomatosis Gomez-Portilla et al, 1999) gastric cancer with peritoneal carcinomatosis (Yonemura et al, 2003), and peritoneal sarcomatosis (Rossi et al, 2004;Berthet et al, 1999). The completeness of cytoreduction score in advanced ovarian cancer has been demonstrated to be a significant prognostic indicator of survival Tentes et al, 2006;Piso et al, 2004;Raspagliesi et al, 2006;Di Giorgio et al, 2008 (Tentes et al, 2006).…”

“…Patients with diseases that have similar biological behavior to ovarian cancer are offered significant survival benefit when they are treated with perioperative intraperitoneal chemotherapy integrated in cytoreductive surgery. In pseudomyxoma peritonei (Sugarbaker, 2006), peritoneal sarcomatosis (Rossi et al, 2004), peritoneal mesothelioma (Yan et al, 2007), colorectal cancer with peritoneal dissemination (Elias et al, 2009;Mahteme et al, 2004;Verwaal et al, 2008), as well as in gastric cancer with peritoneal carcinomatosis (Yonemura et al, 1996;Yu et al, 1998) survival is improved with this treatment strategy. The last two decades the method has been used in ovarian cancer with promising results.…”

Pharmacologic rationale for treatments of peritoneal surface malignancy from colorectal cancer

“…The total amount of cancer chemotherapy is mixed in a large volume of carrier solution (usually 6 L) that is placed in a reservoir. For example, Deraco et al [69,70] have used doxorubicin at 15.25 mg/m 2 per liter and cisplatin at 43 mg/m 2 per liter with the total volume of 6 L. Gilly and coworkers have used mitomycin C at 0.5 mg/kg and cisplatin at 0.7 mg/kg in a total volume of 4 to 6 L [71,72] . In this method, the amount of chemotherapy solution in contact with the peritoneal surface is determined by multiple variables, in addition to the body surface area; the amount of distention (between 2 and 6 L) of the abdominal cavity induced by the chemotherapy solution, the patient's sex, the amount of ascites present preoperatively and the extent of the visceral resection.…”

Perioperative fast track program in intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) after cytoreductive surgery in advanced ovarian cancer

“…The approach changed from noncommittal attitude toward the diagnosis of peritoneal carcinomatosis to a much more active attitude leading to more aggressive surgery being carried out including peritonectomy procedures and intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). The overall rate of severe perioperative morbidity ranged from 0 to 40% and the mortality rate varied from 0 to 10% (22-29), with a mean hospital stay of over two weeks (21,23,26,31,33).…”