Complete cytoreductive surgery plus HIPEC for peritoneal metastases from unusual cancer sites of origin: results from a worldwide analysis issue of the Peritoneal Surface Oncology Group International (PSOGI)

Our plain-English summary of Complete cytoreductive surgery plus HIPEC for peritoneal metastases from unusual cancer sites of origin: results from a worldwide analysis issue of the Peritoneal Surface Oncology Group International (PSOGI), by D. Goéré, G. Passot, M. Gelli, et al (International Journal of Hyperthermia, 2017).

The study

• Authors: D. Goéré, G. Passot, M. Gelli, E.A. Levine, D.L. Bartlett, P.H. Sugarbaker, O. Glehen
• Journal: International Journal of Hyperthermia
• Published: 2017;33(5):520-527
• Cited by: 64 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Aim: The aim of this study was to assess the outcomes of patients operated on for peritoneal metastases from unusual cancer sites of origin, meaning apart from peritoneal metastases (PM) from colorectal, gastric and epithelial ovarian carcinomas, pseudomyxoma peritonei and mesothelioma.

Patients And Methods: A questionnaire concerning patients treated with cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) for PM arising from unusual cancer sites of origin was sent to all centres, which routinely performed HIPEC, through the Peritoneal Surface Oncology Group International and the RENAPE network.

Results: Between September 1990 and June 2016, 850 procedures for unusual cases were performed in 781 patients, in 53 centres worldwide. Nearly two-thirds of the procedures were performed for three indications: rare ovarian carcinoma (n = 224), sarcoma (n = 189) and neuroendocrine tumours (n = 127). The median PCI was 12 [0-39]. Grade III-IV postoperative complications occurred in 272 patients (41%). Nineteen patients (2.9%) died postoperatively. After a median follow-up of 46 months, median overall survival (OS) was 39 months [33.18-44.05]. Five-year OS rate was 38.7%. For the three main indications, 5-year OS was significantly greater in patients with PM from rare ovarian carcinoma (57.7%), than that of patients with PM from neuroendocrine tumours (39.9%), and from sarcoma (29.3%) (p < 0.0001).

Conclusions: CRS and HIPEC appear to be safe and effective in patients with peritoneal metastases from unusual cancer sites of origin, especially from rare ovarian carcinomas, PM from neuroendocrine tumours. The respective roles of CRS and HIPEC remain unclear and should be evaluated.

In plain English

This study did not examine asbestos exposure, and it excluded patients with mesothelioma. It was a retrospective analysis of patients treated in 53 centers worldwide with cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (HIPEC, heated chemotherapy delivered into the abdomen) for peritoneal metastases (cancer spread to the abdominal lining) from unusual cancer sites of origin. Between September 1990 and June 2016, 781 patients were included. The most common origins were less common ovarian carcinoma subtypes, sarcoma and neuroendocrine tumors. Grade III-IV complications occurred in 272 patients (41%), and 19 patients (2.9%) died after surgery. Among 734 patients analyzed for survival, median overall survival was 39.45 months (interval reported as 33.18 to 44.05 months) and 5-year survival was 38.7%. Five-year survival was 57.7% for rare ovarian carcinoma, 39.9% for neuroendocrine tumors and 29.3% for sarcoma. The authors concluded that the treatment appears safe and effective for these patients, especially those with rare ovarian carcinomas and neuroendocrine tumors, but that the respective roles of surgery and HIPEC remain unclear. They noted that the analysis was retrospective and the cohort highly selected.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective multicenter analysis of data collected by questionnaire from member centers of PSOGI and the BIG-RENAPE network
• Who was studied: 781 patients (548 women, 233 men; median age 52.8 years) treated in 53 centers worldwide between September 1990 and June 2016. They had peritoneal metastases from unusual cancer sites of origin. Colorectal, gastric and epithelial ovarian carcinomas, pseudomyxoma peritonei and mesothelioma were excluded. Of 850 procedures, 820 were included in the analysis.
• Exposure: No asbestos exposure was studied. The study examined a treatment: cytoreductive surgery followed by HIPEC. The HIPEC drugs included cisplatin, mitomycin C, oxaliplatin, doxorubicin and irinotecan.
• Main results:
  • Across all patients, grade III-IV postoperative complications occurred in 272 patients (41%), and 19 patients (2.9%) died postoperatively.
  • In the entire cohort (734 patients analyzed for overall survival), median overall survival was 39.45 months [33.18-44.05]. Overall survival was 77.8% at 1 year, 52.2% at 3 years and 38.7% at 5 years.
  • Five-year overall survival differed significantly between the three main groups: 57.7% for rare ovarian carcinoma, 39.9% for neuroendocrine tumors and 29.3% for sarcoma (p less than 0.0001).
  • Five-year overall survival was 46.1% when the PCI (a score of disease extent) was below 10, 38.2% when it was 10 to 14, and 31.9% when it was 15 or more.
  • In the multivariate analysis, the following were independent negative prognostic factors for overall survival: preoperative chemotherapy (HR 1.72, 95% CI 1.26-2.35), lymph node involvement (HR 1.99, 95% CI 1.39-2.85), postoperative chemotherapy (HR 1.54, 95% CI 1.11-2.14), CC-2 residual tumor (HR 2.57, 95% CI 1.65-4.02) and etiology. The PCI was not an independent prognostic factor.
  • For patients analyzed for disease-free survival, median disease-free survival was 18.9 months [15.7-22.4]. Disease-free survival rates were 61.2% at 1 year, 33.2% at 3 years and 28% at 5 years.
  • Five-year disease-free survival was 38.9% for ovarian carcinoma, 40.2% for neuroendocrine tumors and 14.3% for sarcoma (p less than 0.0001).
• The authors' conclusion: The authors concluded that CRS and HIPEC appear to be safe and effective in patients with peritoneal metastases from rare cancer sites of origin. In their view, the best candidates seem to be patients with rare ovarian carcinomas and neuroendocrine tumors, and the respective roles of CRS and HIPEC remain unclear.
• Limitations the authors state:
  • The analysis was retrospective and covered patients treated over a long time interval.
  • The cohort was highly selected and represented only a fraction of patients with peritoneal metastases from uncommon cancer sites.
  • Techniques and drugs varied between centers, so the study could not show that any technique or drug was superior.
  • The exact role of HIPEC remains to be clarified.

Topics

Medical terms in this study, explained in our Lexicon: Cytoreductive Surgery, HIPEC, Peritoneal Surface Oncology, Carcinoma, Mesothelioma, Sarcoma, Median Overall Survival.

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• Is Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy Justified for Biphasic Variants of Peritoneal Mesothelioma? Outcomes from the Peritoneal Surface Oncology Group International Registry — K.I. Votanopoulos, P. Sugarbaker, et al. (2018)
• A proposal of Brazilian Society of Surgical Oncology (BSSO/SBCO) for standardizing cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) procedures in Brazil: pseudomixoma peritonei, appendiceal tumors and malignant peritoneal mesothelioma — T.P. Batista, B.J.Q. Sarmento, et al. (2017)
• Laparoscopic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for limited peritoneal metastasis. The PSOGI international collaborative registry — A. Arjona-Sanchez, O. Aziz, et al. (2021)
• Repeat Cytoreductive Surgery and HIPEC for Peritoneal Surface Malignancy and Peritoneal Carcinomatosis — J.F. Wong, G.H. Tan, et al. (2015)
• Peritoneal metastases from small bowel cancer: Results of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in The Netherlands — T.R. van Oudheusden, V.E. Lemmens, et al. (2015)
• Conversion to Complete Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Malignant Peritoneal Mesothelioma After Bidirectional Chemotherapy — F. Le Roy, M. Gelli, et al. (2017)

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