“PAUSE”: a method for communicating radiological extent of peritoneal malignancy

Chandramohan, Anuradha; Thrower, Andrew; Smith, Steve; Shah, Nehal; Moran, Brendan

doi:10.1016/j.crad.2017.07.005

Cited by 31 publications

(18 citation statements)

References 27 publications

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“…The present results suggest that discussing patients at a national PM MDT helps to select patients most likely to benefit from intervention. Radiology is crucial, and an experienced peritoneal malignancy radiologist helps to identify unfavourable anatomical sites of disease that preclude complete cytoreduction such as extensive small bowel serosal and/or porta hepatis disease. CT is currently the main imaging modality, but there may be a role for diffusion‐weighted MRI, particularly when assessing small bowel involvement.…”

Section: Discussionmentioning

confidence: 99%

Clinical and surgical outcomes of patients with peritoneal mesothelioma discussed at a monthly national multidisciplinary team video-conference meeting

et al. 2020

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Background Peritoneal mesothelioma (PM) is a rare primary neoplasm of the peritoneum with an increasing incidence worldwide. Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has shown promise as a treatment strategy. A national PM multidisciplinary team (national PM MDT) video‐conference meeting was established in the UK and Ireland in March 2016, aiming to plan optimal treatment, record outcomes and provide evidence for the benefits of centralization. This article reports on the activities and outcomes of the first 2·5 years. Methods Between March 2016 and December 2018, patients with PM, referred to peritoneal malignancy centres in Basingstoke, Birmingham, Manchester and Dublin, were discussed by the national PM MDT via video‐conference. The MDT was composed of surgeons, radiologists, specialist nurses and pathologists. Patients were considered for CRS and HIPEC if considered fit for surgery and if radiological imaging suggested that complete surgical cytoreduction could be achieved. Morbidity and mortality following surgery were analysed. Survival analysis following MDT discussion was conducted. Results A total of 155 patients (M : F ratio 0·96) with a mean(s.d.) age of 57(17) years were discussed. To date, 22 (14·2 per cent) have had CRS and HIPEC; the median Peritoneal Cancer Index for the surgical group was 17·0. Complete cytoreduction was achieved in 19 patients. Clavien–Dindo grade I–II complications occurred in 16 patients; there was no grade III–IV morbidity or 30‐day in‐hospital mortality. The median follow‐up for the whole cohort was 18·7 months, and the 2‐year survival rate from time of first review at the national PM MDT was 68·3 per cent. Conclusion The centralized national PM MDT was effective at selecting patients suitable for CRS and HIPEC, reporting a good outcome from patient selection.

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Section: Discussionmentioning

confidence: 99%

Clinical and surgical outcomes of patients with peritoneal mesothelioma discussed at a monthly national multidisciplinary team video-conference meeting

et al. 2020

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“…Evaluation of CPM extent and distribution would benefit from similar standardisation though this has yet to see widespread implementation. The PAUSE algorithm proposed by Chandramohan and colleagues offers an elegant solution designed to provide a common language for communicating imaging findings in CPM [105]. Briefly, the acronym incorporates: P (primary tumour and peritoneal carcinomatosis index), A (ascites and abdominal wall involvement), U (unfavourable sites of involvement), S (small bowel and mesenteric disease), and E (extraperitoneal metastases).…”

Section: Discussionmentioning

confidence: 99%

Colorectal Peritoneal Metastases: A Systematic Review of Current and Emerging Trends in Clinical and Translational Research

Koumpa

Xylas

Konopka

et al. 2019

Gastroenterology Research and Practice

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Colorectal peritoneal metastases (CPM) are associated with abbreviated survival and significantly impaired quality of life. In patients with CPM, radical multimodality treatment consisting of cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has demonstrated oncological superiority over systemic chemotherapy alone. In highly selected patients undergoing CRS + HIPEC, overall survival of over 60% has been reported in some series. These are patients in whom the disease burden is limited and where the diagnosis is made at an early stage in the disease course. Early diagnosis and a deeper understanding of the biological mechanisms that regulate CPM are critical to refining patient selection for radical treatment, personalising therapeutic approaches, enhancing prognostication, and ultimately improving long-term survivorship. In the present study, we outline three broad themes which represent critical future research targets in CPM: (1) enhanced radiological strategies for early detection and staging; (2) identification and validation of translational biomarkers for diagnostic, prognostic, and therapeutic deployment; and (3) development of optimized approaches for surgical cytoreduction as well as more precise strategies for intraperitoneal drug selection and delivery. Herein, we provide a contemporary narrative review of the state of the art in these three areas. A systematic review in accordance with PRISMA guidelines was undertaken on all English language studies published between 2007 and 2017. In vitro and animal model studies were deemed eligible for inclusion in the sections pertaining to biomarkers and therapeutic optimisation, as these areas of research currently remain in the early stages of development. Acquired data were then divided into hierarchical thematic categories (imaging modalities, translational biomarkers (diagnostic/prognostic/therapeutic), and delivery techniques) and subcategories. An interactive sunburst figure is provided for intuitive interrogation of the CPM research landscape.

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“…There have been many attempts to preoperatively predict possibility of complete cytoreduction based on imaging findings and laparoscopy. [15][16][17][18][19][20][21][22] In a recent two center study, age over 60 years, cancer antigen (CA) 125 levels >550 IU/L and peritoneal cancer index of >16 were identified as significant factors associated with suboptimal cytoreduction at interval debulking. 23 It is vital for radiologists to develop an understanding of the practices surrounding the management of patients with ovarian cancer in their own centers and deliver reports that caters to such decision-making.…”

Section: Staging Prognosis and Management Strategiesmentioning

confidence: 99%

“…24 The recommended imaging protocol is CECT of the thorax, abdomen, and pelvis, in arterial and venous phase; with positive or neutral oral contrast; reconstructed as 3 mm sections; images reviewed in axial and coronal planes. 20 Nearly 30% of patients with pleural effusion can have mediastinal nodes, pleural or lung metastases, and thus it is useful to include thorax in the imaging protocol. 25 There are mixed opinions regarding the use of positive oral contrast.…”

Section: Imaging For Staging Ovarian Cancermentioning

confidence: 99%

“…Spread of ovarian cancer to certain key anatomic structures would either increase the complexity of surgery or prelude cytoreductive surgery since complete cytoreduction becomes unlikely. 15,18,20,25 In a setting of ovarian cancer or primary peritoneal cancer, these include thick (> 2 cm) sheet like subphrenic disease, disease in the fissures for falciform ligament and ligamentum teres, infiltrating liver and splenic surface deposits >2 cm, lesser sac, porta hepatis and porto-caval space, biliary obstruction, lesser omentum, perigastric disease encasing the stomach and the left gastric artery, disease in the root of mesentery, small bowel serosal disease, retroperitoneal spread to perinephric and paranephric space, presacral space, pelvic side wall infiltration, and large paramedian abdominal wall disease (►Table 4, ►Figs. 7-11).…”

Section: Unfavorable Sites Of Involvementmentioning

confidence: 99%

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Management Driven Structured Reporting in Ovarian Cancer

Chandramohan

Panda

Thomas

et al. 2019

Journal of Gastrointestinal and Abdominal Radiology

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Since majority (80%) of ovarian cancer patients present at an advanced stage, imaging performed on these patients have numerous findings. The combination of multiple findings on imaging, complexity of anatomical structures which are involved in ovarian cancer, and the need to perceive certain subtle imaging features which would impact management often makes it challenging to systematically review images of these patients. Similarly, it is difficult to effectively communicate these findings in radiology reports. Structured reporting that is geared toward clinical decision-making has been an area of recognized need. An understanding of the review areas, which aid clinical decision-making in a multidisciplinary team setting at our institution led us to the proposed structured reporting template for ovarian cancer. Through this review, the authors would like to share this reporting template with examples.

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“PAUSE”: a method for communicating radiological extent of peritoneal malignancy

Cited by 31 publications

References 27 publications

Clinical and surgical outcomes of patients with peritoneal mesothelioma discussed at a monthly national multidisciplinary team video-conference meeting

Clinical and surgical outcomes of patients with peritoneal mesothelioma discussed at a monthly national multidisciplinary team video-conference meeting

Colorectal Peritoneal Metastases: A Systematic Review of Current and Emerging Trends in Clinical and Translational Research

Management Driven Structured Reporting in Ovarian Cancer

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