Neoadjuvant Intraperitoneal Chemotherapy in Patients with Pseudomyxoma Peritonei—A Novel Treatment Approach

Prabhu, Aruna; Brandl, Andreas; Wakama, Satoshi; Sako, Shouzou; Ishibashi, Hiroyuki; Mizumoto, Akiyoshi; Takao, Nobuyuki; Noguchi, Kousuke; Motoi, Shunsuke; Ichinose, Masumi; Liu, Yang; Yonemura, Yutaka

doi:10.3390/cancers12082212

Cited by 6 publications

(8 citation statements)

References 34 publications

(41 reference statements)

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“…The application of preoperative intraperitoneal chemotherapy in PMP has only been reported in some case reports and small sample studies, which showed a good result [12][13]. Strati ed analysis in this study shows that preoperative intraperitoneal chemotherapy tends to prolong survival.…”

Section: Natural Course Of Pmpmentioning

confidence: 56%

Analysis of diagnosis and treatment status of pseudomyxoma peritonei based on Chinese real-world data

Zhang

Zhao

Lin

et al. 2022

Preprint

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Objective To analyze the diagnosis and treatment status, natural course, and related factors of patients with pseudomyxoma peritonei based on Chinese real-world data. Methods Retrospective analysis was conducted on real world data of PMP patients with a complete natural history at the our center from February 2009 to July 2020, including clinicopathological characteristics, non-standardized treatment (time of misdiagnosis, time of mistreatment, previous anti-tumor treatment), CRS + HIPEC treatment (operation time, intraoperative blood transfusion, PCI score, CC score, number of organ removed, number of peritoneal resection areas, serious adverse events (SAE)), and the end point of follow-up was death due to disease-specific death. The natural course and the postoperative course of disease and related factors were analyzed. Results a total of 142 patients were included, 83 (58.5%) males and 59 (41.5%) females, the median age was 55 (24~79) years old, the median time of misdiagnosis was 0.8 (0~62.5) months, and the median time of mistreatment was 15.6 (0~411.1) months. The median time of misdiagnosis and mistreatment after 2016 was shorter than that before. All patients were treated with CRS + HIPEC. The median operation time was 10 (3.33~16.5) h, and the median PCI score was 33 (3~39). The median overall survival of the natural course was 30.3 (2.4~416.7) months, and the 1 -, 2 -, 3-and 5-year survival rates were 90.1%, 62.7%, 43.7% and 19.7%, respectively. Multivariate analysis showed that there were three independent prognostic factors affecting the natural course: PSS 1–3 (HR = 0.472, 95%CI:0.324 ~ 0.688, P = 0.000), lymph node metastasis (HR = 2.219, 95%CI:1.226 ~ 4.014, P = 0.008), and number of CRS + HIPEC operations (HR = 0.523, 95%CI:0.353 ~ 0.777, P = 0.001). Median postoperative survival was 11.93 (0.03~79.70) months, and the 1 -, 2 -, 3-and 5-year postoperative survival rates were 49.3%, 19.7%, 10.6% and 1.4%, respectively. Multivariate analysis showed that there were five independent prognostic factors affecting the postoperative course: previous targeted therapy (HR = 1.628, 95%CI:1.017 ~ 2.607, P = 0.042), occurrence of serious adverse events (SAE) (HR = 1.562, 95%CI:1.053 ~ 2.317, P = 0.026), preoperative CEA level > 39.29 ng/mL (HR = 0.667, 95%CI:0.462 ~ 0.963, P = 0.031), postoperative adjuvant therapy (HR = 0.418, 95%CI:0.284 ~ 0.614, P = 0.000). Postoperative SAE occurred in 44 cases (31%), and 4 cases (2.8%) died within 30 days after operation. Preoperative thrombosis and previous intravenous chemotherapy are independent influencing factors of SAE. Conclusion The diagnosis and treatment of PMP in China has a trend of improvement year by year, and CRS + HIPEC is still the standard treatment for PMP. Early diagnosis and the popularization and application of CRS + HIPEC procedures still need to be strengthened. How to reduce postoperative complications is still a problem that we need to solve.

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Section: Natural Course Of Pmpmentioning

confidence: 56%

Analysis of diagnosis and treatment status of pseudomyxoma peritonei based on Chinese real-world data

Zhang

Zhao

Lin

et al. 2022

Preprint

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“…The potential role of neoadjuvant intraperitoneal chemotherapy was already emphasized in other appendiceal entities (pseudomyxoma) [ 38 ]. The probable effectiveness of other types of intraperitoneal administrations in the context of peritoneal disease of appendiceal origin adds to the rationale of PIPAC, in spite of the clinical setting of the present study that is limited to appendiceal adenocarcinoma [ 12 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

Assessment of Treatment Response after Pressurized Intra-Peritoneal Aerosol Chemotherapy (PIPAC) for Appendiceal Peritoneal Metastases

Somashekhar

Abba

Sgarbură

et al. 2022

Cancers

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Background The aim of this study was to analyse survival and surrogates for oncological response after PIPAC for appendiceal tumours. Methods This retrospective cohort study included consecutive patients with appendiceal peritoneal metastases (PM) treated in experienced PIPAC centers. Primary outcome measure was overall survival (OS) from the date of diagnosis of PM and from the start of PIPAC. Predefined secondary outcome included radiological response (RECIST criteria), repeat laparoscopy and peritoneal cancer index (PCI), histological response assessed by the Peritoneal regression grading system (PRGS) and clinical response. Results Final analysis included 77 consecutive patients (208 PIPAC procedures) from 15 centres. Median OS was 30 months (23.00–46.00) from time of diagnosis and 19 months (13.00–28.00) from start of PIPAC. 35/77 patients (45%) had ≥3 procedures (pp: per protocol). Objective response at PIPAC3 was as follows: RECIST: complete response 4 (11.4%), 11 (31.4%) partial/stable; mean PRGS at PIPAC3: 1.8 ± 0.9. Median PCI: 21 (IQR 18–27) vs. 22 (IQR 17–28) at baseline (p = 0.59); 21 (60%) and 18 (51%) patients were symptomatic at baseline and PIPAC3, respectively (p = 0.873). Median OS in the pp cohort was 22.00 months (19.00-NA) from 1st PIPAC. Conclusion Patients with PM of appendiceal origin had objective treatment response after PIPAC and encouraging survival curves call for further prospective evaluation.

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“…The treatment course was repeated every 3 weeks for 3 courses. 14 Four to 6 weeks after the last cycle of preoperative chemotherapy, patients received r-CRS combined with upper-abdominal partial peritonectomy or l-CRS combined with upper-abdominal partial peritonectomy. The inclusion criteria were (1) patients diagnosed as having PMP with limited peritoneal surface malignancy (PSM) that was confined to the upper-abdominal parietal peritoneum (PCI <10) and some implants in the omentum by staging laparoscopy performed preliminarily; and (2) absence of a huge intra-abdominal mass that was difficult to handle by robotic approach.…”

Section: Methodsmentioning

confidence: 99%

Feasibility of Robot-Assisted Cytoreductive Surgery With Upper-Abdominal Peritonectomy for Pseudomyxoma Peritonei With Low Peritoneal Carcinomatosis Index: A Pilot Study

Fujimoto,

Yonemura,

Taniguchi

et al. 2024

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

Self Cite

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Introduction: Our study’s objective was to provide the method for, and preliminary findings from, robot-assisted cytoreductive surgery (r-CRS) combined with upper-abdominal peritonectomy in pseudomyxoma peritonei (PMP) with limited peritoneal surface malignancy (PSM). Materials and Methods: We conducted a retrospective pilot study on consecutive patients with PSM secondary to pseudomyxoma peritonei with a peritoneal cancer index (PCI) of under 10 who were indicated for r-CRS combined with upper-abdominal peritectomy. Perioperative and 30-day major morbidity and mortality characteristics were analyzed and compared with cases in which laparoscopic CRS (l-CRS) was performed under the same conditions. Results: Six patients underwent r-CRS combined with an upper-abdominal partial peritonectomy. Their mean PCI was 4.83. Complete cytoreduction was achieved in all patients. The mean duration of the operation was 156.8 minutes. There was no major complication and no mortality. The mean length of hospital stay after surgery was 6.33 days. r-CRS resulted in less blood loss, a lower C-reactive protein level, and a shorter length of hospital stay that were significantly different compared with those of l-CRS. Conclusions: This is the initial technical report of a robotic approach for CRS combined with upper-abdominal peritonectomy. r-CRS with a combined upper-abdominal peritonectomy was shown to be safe and feasible for PMP with limited PSM.

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Neoadjuvant Intraperitoneal Chemotherapy in Patients with Pseudomyxoma Peritonei—A Novel Treatment Approach

Cited by 6 publications

References 34 publications

Analysis of diagnosis and treatment status of pseudomyxoma peritonei based on Chinese real-world data

Analysis of diagnosis and treatment status of pseudomyxoma peritonei based on Chinese real-world data

Assessment of Treatment Response after Pressurized Intra-Peritoneal Aerosol Chemotherapy (PIPAC) for Appendiceal Peritoneal Metastases

Feasibility of Robot-Assisted Cytoreductive Surgery With Upper-Abdominal Peritonectomy for Pseudomyxoma Peritonei With Low Peritoneal Carcinomatosis Index: A Pilot Study

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