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- Bushati, M., et al.
(författare)
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The current practice of cytoreductive surgery and HIPEC for colorectal peritoneal metastases : Results of a worldwide web-based survey of the Peritoneal Surface Oncology Group International (PSOGI)
- 2018
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Ingår i: European Journal of Surgical Oncology. - : ELSEVIER SCI LTD. - 0748-7983 .- 1532-2157. ; 44:12, s. 1942-1948
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Tidskriftsartikel (refereegranskat)abstract
- Background: At present, selected patients with resectable colorectal peritoneal metastases (CRC-PM) are increasingly treated with a combination therapy of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). The aim of this study was to investigate the current worldwide practice.Methods: HIPEC experts from 19 countries were invited through the Peritoneal Surface Oncology Group International (PSOGI) to complete an online survey concerning their personal expertise and current hospital and country wide practice.Results: It is estimated that currently more than 3800 patients with CRC-PM (synchronous and metachronous) are annually treated with CRS and HIPEC in 430 centers. Integration of CRS and HIPEC in national guidelines varies, resulting in large treatment disparities between countries. Amongst the experts, there was general agreement on issues related to indication, surgical technique and follow up but less on systemic chemotherapy or proactive strategies.Conclusion: This international survey demonstrates that CRS and HIPEC is now performed on a large scale for CRC-PM patients. Variation in treatment may result in heterogeneity in surgical and oncological outcomes, emphasising the necessity to reach consensus on several issues of this comprehensive procedure. Future initiatives directed at achieving an international consensus statement are needed.
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| 4. |
- Yonemura, Y., et al.
(författare)
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A comprehensive treatment for peritoneal metastases from gastric cancer with curative intent
- 2016
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Ingår i: European Journal of Surgical Oncology. - : Elsevier BV. - 0748-7983 .- 1532-2157. ; 42:8, s. 1123-1131
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Forskningsöversikt (refereegranskat)abstract
- Recently, Peritoneal Surface Oncology Group International (PSOGI) developed a novel comprehensive treatment consisting of cytoreductive surgery (CRS) and perioperative chemotherapy (POC) for the treatment of peritoneal metastases (PM) from gastric cancer with curative intent. This article reviews the results of this treatment and verifies its indication. In this strategy, peritoneal cancer index (PCI) is determined by laparoscopy, and a peritoneal port is placed. Neoadjuvant bidirectional intraperitoneal/systemic chemotherapy (NIPS) is performed for 3 cycles, and then laparotomy is performed. Cytoreductive surgery with peritonectomy procedures and hyperthermic intraperitoneal chemoperfusion (HIPEC) are performed. Multivariate analyses showed that completeness of cytoreduction, pathologic response to NIPS and PCI level and cytologic status after NIPS, as independent prognostic factors. PCI less than cut-off level after NIPS, negative cytology after NIPS, and positive response to NIPS were identified as the indications for comprehensive treatment. Patients who hold these criteria should be considered as the candidates for CRS and HIPEC.
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| 6. |
- van de Vlasakker, Vincent C. J., et al.
(författare)
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The impact of PRODIGE 7 on the current worldwide practice of CRS-HIPEC for colorectal peritoneal metastases : A web-based survey and 2021 statement by Peritoneal Surface Oncology Group International (PSOGI)
- 2021
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Ingår i: European Journal of Surgical Oncology. - : Elsevier. - 0748-7983 .- 1532-2157. ; 47:11, s. 2888-2892
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionThe PRODIGE 7-trial investigated the additional value of Hyperthermic Intraperitoneal Chemotherapy (HIPEC) to cytoreductive surgery (CRS) for patients with colorectal peritoneal metastases (CPM). The results of PRODIGE 7 were presented at the 2018 ASCO meeting showing that 30 min oxaliplatin-based HIPEC did not improve overall survival. The current study investigated the impact of PRODIGE 7 on the worldwide practice of CRS and HIPEC.Materials and methodsCRS-HIPEC experts from 19 countries were invited through the Peritoneal Surface Oncology Group International (PSOGI) to complete an online survey concerning the current CRS-HIPEC practice in their hospital and country, and were asked to appraise the effect of PRODIGE 7.ResultsThe survey was completed by 18/19 experts. Although their personal opinions of CRS-HIPEC were barely influenced by PRODIGE 7, they reported a substantial impact on daily practice. This included a switch towards Mitomycin-C based HIPEC-regimens and prolongation of HIPEC perfusion time, a reduction in the number of referrals from non-HIPEC centers, a reduction in national consensus, the removal of HIPEC from national guidelines, and a reduced reimbursement rate.ConclusionThe PRODIGE 7 has had a major impact on the practice of CRS-HIPEC for CPM worldwide. HIPEC remains an attractive option with potential for control and eradication of disease and further studies into the optimal HIPEC-regimen are urgently needed. Meanwhile, given the complexity of the treatment of patients with CPM, and the proven benefits of optimal CRS, referral of patients with potentially resectable CPM to expert centers is recommended whilst the precise role of HIPEC is further evaluated.
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| 7. |
- Van der Speeten, Kurt, et al.
(författare)
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A pharmacologic analysis of intraoperative intracavitary cancer chemotherapy with doxorubicin
- 2009
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Ingår i: Cancer Chemotherapy and Pharmacology. - : Springer Science and Business Media LLC. - 0344-5704 .- 1432-0843. ; 63:5, s. 799-805
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: A pharmacologic analysis of intracavitary doxorubicin in the treatment of patients with intracavitary cancer dissemination was performed to further evaluate the possible benefits of this treatment modality. METHODS: Twenty appendiceal malignancy patients with peritoneal carcinomatosis (PC), three appendiceal malignancy patients with direct extension into the pleural cavity, 20 patients with peritoneal mesothelioma and one patient with pleural mesothelioma were available for pharmacologic monitoring. After intraperitoneal or intrapleural administration of doxorubicin, plasma and peritoneal fluid samples were obtained at 15, 30, 45, 60 and 90 min in all patients. After intrapleural administration, plasma and pleural fluid samples were collected at similar intervals. Tumor and normal tissues were obtained when available. Doxorubicin concentrations were determined by high-performance liquid chromatography (HPLC). RESULTS: Intraperitoneal doxorubicin showed a prolonged retention in the peritoneal cavity. Doxorubicin concentrations in tumor tissue were consistently elevated above intraperitoneal concentrations from 30 through 90 min. For appendiceal malignancy, the concentrations of doxorubicin were significantly higher in minimally aggressive mucinous tumors. Pleural chemotherapy solutions retained doxorubicin to a greater extent than peritoneal fluid. CONCLUSIONS: Doxorubicin shows characteristics favorable for intracavitary administration with sequestration of doxorubicin in cancer nodules.
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- Van der Speeten, Kurt, 1970-, et al.
(författare)
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Pharmacology of perioperative 5-fluorouracil
- 2010
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Ingår i: Journal of Surgical Oncology. - : Wiley. - 0022-4790 .- 1096-9098. ; 102:7, s. 730-735
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Tidskriftsartikel (refereegranskat)abstract
- Background The purpose of this study was to analyze our current pharmacologic data regarding the perioperative use of 5-fluorouracil in the treatment of peritoneal surface malignancies. Methods Twenty-nine patients with peritoneal carcinomatosis from appendiceal malignancy were included in this pharmacological study. Results In the nine patients who received early postoperative intraperitoneal chemotherapy, the area under the curve for intraperitoneal 5-fluorouracil was 43,000 (+20,300) µg/ml x minutes and for intravenous 5-fluorouracil was 157 (+99) µg/ml x minutes. The area under the curve ratio was 422 (+360). In 20 patients who received intravenous 5-fluorouracil in the operating room intraperitoneal 5-fluorouracil levels maintained a higher level as compared to the intravenous drug level over the 90 minutes of drug sampling. The area under the curve ratio of peritoneal fluid to plasma was 2.3 (+1.3). The area under curve ratio of peritoneal fluid to tumor nodules was 9.9 (+9.8). The area under the curve ratio of plasma to tumor nodules was 5.2 (+4.7). Conclusions By modulating the route or timing of administration of 5-fluorouracil, it becomes a pharmacologic advantageous molecule in patients with peritoneal carcinomatosis of an appendiceal malignancy. 5-fluorouracil remains the cornerstone of the perioperative management of peritoneal carcinomatosis of gastrointestinal origin.
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| 9. |
- Van der Speeten, Kurt, et al.
(författare)
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Toxicity of a Uniform Combined Bidirectional Hyperthermic and Perioperative Intraperitoneal Chemotherapy Regimen after Cytoreductive Surgery in 147 Peritoneal Surface Malignancy Patients
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- BackgroundCurrently, the treatment of peritoneal surface malignancy is managed in selected patients by the combination of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). The chemotherapy agents utilized are selected from response rates in the treatment of gross disease and from pharmacologic studies. These agents are then subjected to morbidity/mortality studies to establish the safety of the treatment. The aim of this study was to analyze the morbidity and mortality of a new bidirectional hyperthermic and perioperative intraperitoneal chemotherapy regimen used after cytoreductive surgery.Materials and MethodsPatients (n=147) with peritoneal surface malignancy received a uniform treatment of cytoreductive surgery combined with intraoperative chemotherapy. HIPEC with mitomycin C and doxorubicin was supplemented with intravenous 5-fluorouracil and leucovorin. In 65 patients, additional early postoperative intraperitoneal (EPIC) 5-fluorouracil was added to the HIPEC for the first four postoperative days. The clinical factors were cataloged prospectively and any adverse events (AE) were tabulated. ResultsIn 85% of patients, complete cytoreduction was achieved. There was an increase in grade IV AE in patients with incomplete cytoreduction (p<0.04) and in patients receiving fresh frozen plasma (p<0.001). For both grades III and IV AE, a right colon resection increased morbidity (p<0.02) and chemotherapy treatment HIPEC plus EPIC increased morbidity, compared to HIPEC alone (p<0.05). The overall morbidity (grades I-IV) was 64% and mortality was 0.6%.ConclusionThe new bidirectional hyperthermic and perioperative intraperitoneal chemotherapy regimen used after CRS can be safely applied in peritoneal carcinomatosis patients.
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