Pleura and Peritoneum

Our medical research library holds 17 studies published in Pleura and Peritoneum (2018–2026). Each entry links to the study's record on PubMed and, where there is one, to the publisher's page and a free full text. 16 have an abstract, the authors' own summary as PubMed records it: open "Abstract" to read it.

About the journal

• Publisher: Walter de Gruyter GmbH
• Published: 2016 to the present, Germany
• Language: English
• ISSN: 2364-768X (electronic), 2364-7671 (print)
• Its record in the NLM Catalog

2020s

• Third French Congress on Mesothelioma. 2026;11(2):89-98. PubMed · Publisher · Free full text

• Co-occurrence of peritoneal mesothelioma and genitourinary cancers: a case series with comparative outcomes. E.M. Bradley, J.L. Rogers, M.C. Kuo, et al. 2025;10(4):177-184. PubMed · Publisher · Free full text

  Abstract

  Objectives: Peritoneal mesothelioma (PM) shares features with genitourinary (GU) malignancies, including histologic appearance, embryologic origin and genetic predispositions. However, data on their co-occurrence are limited. The study presents a case series of PM patients with associated GU malignancies and explores outcomes following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC).

  Methods: A prospectively maintained CRS-HIPEC database from a tertiary referral center (2011-2024) was reviewed. Demographics, tumor characteristics and outcomes were compared between PM patients with and without GU malignancies (including gynecologic and urologic cancers).

  Results: Among 237 CRS-HIPEC patients, 8/17 patients with PM were found to have another GU malignancy (median age 52.8, 62.5 % male). This included renal cell carcinoma, prostate cancer, ovarian tumors and cervical carcinoma. Most GU malignancies were diagnosed before PM (5/8), two were diagnosed post-CRS-HIPEC, and one synchronously. Three patients reported asbestos exposure; two had BAP1 mutations. Compared to those without GU malignancies, affected patients tended to have higher PCI (19.8 vs. 14.3) and poorer 3-year survival (62.5 vs. 100 %).

  Conclusions: GU malignancy is common among PM patients undergoing CRS-HIPEC and could represent a higher-risk subgroup. These findings raise the hypothesis of a potential association between PM and GU malignancy. Shared origins, oncogenesis of similar cell types, environmental exposures or genetic predispositions may contribute and warrant further investigation.

  © 2025 the author(s), published by De Gruyter, Berlin/Boston.

• Long-term survival in peritoneal mesothelioma treated with 24 consecutive PIPACs. M. Mehdorn, B. Jansen-Winkeln, P. Rhode, et al. 2025;10(3):111-117. PubMed · Publisher · Free full text

  Abstract

  Objectives: Malignant peritoneal mesothelioma (MPM) is a rare disease with unspecific abdominal symptoms which is therefore often diagnosed at an advanced stage. Curative therapy is delivered by radical surgery, whereas palliative therapy consists of systemic chemotherapy. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a laparoscopically applied chemotherapy which was invented to administer high doses of chemotherapy intraperitoneally in palliative cases of peritoneal malignancies.

  Methods: The case of a male patient who received PIPAC treatment as individualized approach for unresectable malignant peritoneal mesothelioma is reported.

  Results: The patient began treatment with PIPAC procedures in 2017 for MPM that was unresectable because of extensive disease on the small bowel and refused systemic chemotherapy as the usual standard of care. We initiated PIPAC with doxorubicin and cisplatin and could reach stable disease within one year of treatment so that the therapy was discontinued for 2.5 years. Due to progressive disease, PIPAC was continued resulting in stable disease for 2 years. In total, the patient received 24 PIPAC procedures with no major surgical or toxic side effects over seven years timespan.

  Conclusions: We report the case of a patient with MPM who could reach long-term survival of seven years due to a total of 24 PIPAC procedures.

  © 2025 the author(s), published by De Gruyter, Berlin/Boston.

• Pressurised intraperitoneal aerosol chemotherapy (PIPAC): the first Australian experience. K. Foley, J. Reid, S. Edwards, et al. 2025;10(1):25-31. PubMed · Publisher · Free full text

  Abstract

  Objectives: Pressurised intraperitoneal aerosol chemotherapy (PIPAC) is a novel surgical technique for patients with peritoneal metastases not amenable to curative treatment. PIPAC delivers pressurised aerosolised chemotherapy using a hyperbaric capnoperitonem established laparoscopically. This study sought to investigate the feasibility and safety of PIPAC in an Australian population.

  Methods: We undertook a cohort analysis of prospectively-collected data on patients undergoing PIPAC across two Australian hospitals. Participants were planned to have three PIPAC procedures, each 6 weeks apart. Study outcomes included post-operative complications including 30-day mortality, length of stay (LOS) and patient quality of life (EORTC QLQ-C30 scores).

  Results: 18 patients underwent 50 completed procedures. 13 patients had two or more PIPACs. The most common primary malignancy was colorectal cancer (n=8), followed by gastric cancer (n=4), appendiceal cancer (n=4) and mesothelioma (n=2). One grade four but no grade five complications occurred, with zero 30-day mortality. Median LOS was 1 day. Mean EORTC QLQ-C30 score increased from 47.8 at baseline to 53 post second PIPAC. Due to the heterogeneity of our cohort, survival analysis and statistical comparisons were unable to be made.

  Conclusion: PIPAC is feasible, safe and well tolerated in an Australian population with a lack of severe complications and zero 30 day mortality. Due to the small number of patients and the heterogeneity of our study's sample, it was not possible to perform survival analysis. The study is nonetheless valuable as the first investigation of implementation of PIPAC in Australia.

  © 2025 the author(s), published by De Gruyter, Berlin/Boston.

• Time till pleuropulmonary recurrence for mesothelioma and high grade appendiceal neoplasm after CRS/HIPEC. T.G. Williams, S. Barat, D.L. Morris. 2025;10(3):129-135. PubMed · Publisher · Free full text

  Abstract

  Objectives: Cytoreductive surgery with heated intraperitoneal chemotherapy (CRS/HIPEC) requiring diaphragmatic stripping or resection may predispose to pleuropulmonary recurrence. This review was to assess the rates of pleuropulmonary recurrence after CRS/HIPEC for patients who had high-grade appendiceal neoplasm and meosthelioma.

  Methods: A retrospective review (September 1996-November 2021) at a single tertiary center identified 716 patients who underwent CRS/HIPEC with diaphragmatic intervention; 203 had high-grade appendiceal neoplasms and 63 had mesothelioma. Radiologic or pathologic evidence of pleuropulmonary recurrence was recorded. Time from CRS/HIPEC to chest recurrence was analyzed using Kaplan-Meier methods.

  Results: Twenty patients (12 appendiceal; 8 mesothelioma) developed pleuropulmonary recurrence. In the appendiceal cohort (mean age 51.5 years; median PCI 30), all 12 underwent bilateral diaphragm intervention (four with full-thickness resection) with CCR 0-1. Time to chest recurrence ranged from 0.3 to 82.8 months; half experienced early respiratory complications (e.g., pleural effusion, pneumothorax). In the mesothelioma cohort (mean age 44.9 years; median PCI 22.1), seven had bilateral stripping (two with resection) and one had unilateral stripping; CCR was 0-1. Recurrence occurred between 8.0 and 85.4 months (median ∼31.4 months); half had early respiratory compromise. No significant associations were observed between PCI, CCR, or extent of diaphragmatic intervention and recurrence risk, although ICU stay and CCR weakly correlated with recurrence in mesothelioma.

  Conclusions: Pleuropulmonary recurrence following CRS/HIPEC with diaphragm intervention is rare (2.7 %), with early recurrences suggesting occult thoracic involvement. Bilateral diaphragm manipulation was common among those with recurrence.

  © 2025 the author(s), published by De Gruyter, Berlin/Boston.

• A study of somatic BRCA variants and their putative effect on protein properties in malignant mesothelioma. K. Krishnamurthy, K.S. Oh, S. Alghamdi, et al. 2023;8(1):19-25. PubMed · Publisher · Free full text

  Abstract

  Objectives: The aim of this study is to analyze the prevalence of somatic mutations in BRCA1 and BRCA2 in malignant mesothelioma and their putative impact on protein properties.

  Methods: Eighteen cases of malignant mesothelioma were retrieved from the archives and for next generation sequencing analysis of BRCA1 and BRCA2 genes. Variants were analyzed using Ensembl VEP17, Polyphen 2.0 software, SIFT software, MutpredV2, and SWISS-MODEL homology-modeling pipeline server.

  Results: BRCA2 variants were found in significantly higher percentage (22%) of cases (p=0.02). Five missense variants were identified. These were p.A2351P, p.T2250A, p.A895V, pG1771D, and p.R2034C. The SIFT scores of all except one were ≥ 0.03. The Polyphen scores of these four alterations were ≤0.899. In case of p.A2315, the SIFT score was 0.01, while the Polyphen 2 score was 0.921. MutPred2 scores were ≤0.180 for all. Loss of intrinsic disorder was predicted (Pr=0.32, p=0.07) for p.R2034C, while gain of intrinsic disorder was predicted for p.A2351P (Pr=0.36, p=0.01) and p.G1771D (Pr=0.34, p=0.02).

  Conclusions: BRCA2 somatic variants were identified in 22% cases of malignant mesotheliomas in this study. The variants localize more frequently to the disordered regions of the protein and are predicted to affect the level of disorder.

  © 2023 the author(s), published by De Gruyter, Berlin/Boston.

• Second annual report from the ISSPP PIPAC database. M.B. Mortensen, F. Casella, Ö. Düzgün, et al. 2023;8(4):141-146. PubMed · Publisher · Free full text

  Abstract

  Objectives: To monitor the results of PIPAC directed therapy based on data from the International Society for the Study of the Pleura and Peritoneum (ISSPP) PIPAC database.

  Methods: Analysis of data from patients entered between June 15th, 2020, and February 28th, 2023.

  Results: Twelve centers reported 2,456 PIPAC procedures in 809 patients (median 2, range 1-18) with peritoneal metastasis (PM) from different primary tumors. Approximately 90 % had systemic chemotherapy prior to PIPAC. Twenty-eight percent were treated in prospective protocols. Overall non-access rate was 3.5 %. Concomitant surgical procedures were performed during PIPAC in 1.6 % of the patients. Median length of stay was 2 days. A total of 95 surgical complications were recorded, but only 22 % of these were graded ≥3b. Seventeen-hundred-and-three adverse events were noted, and 8 % were classified ≥3. The rate of complete or major histological response (peritoneal regression grade score, PRGS≤2) increased between the first and the third PIPAC in the group of patients who were evaluated by PRGS, and a PRGS ≤2 or a reduction of the mean PRGS of at least 1 between first and third PIPAC were observed in 80 %. Disease progression (50 %) or technical issues (19 %) were the most important reasons for stopping PIPAC treatment. Median overall survival from first PIPAC directed treatment varied from 10.7 months (CI 8.7-12.5) in gastric cancer to 27.1 months (16.4-50.5) in mesothelioma.

  Conclusions: The ISSPP PIPAC database provides substantial real-world data supporting the use of PIPAC directed therapy in patients with PM from different primary tumors.

  © 2023 the author(s), published by De Gruyter, Berlin/Boston.

• Sodium thiosulfate during cisplatin-based hyperthermic intraperitoneal chemotherapy is associated with transient hypernatraemia without clinical sequelae. A. Alonso, W. Liauw, H. Kennedy, et al. 2022;7(2):87-93. PubMed · Publisher · Free full text

  Abstract

  Objectives: Cisplatin is commonly used during intraperitoneal chemotherapy however has well-established nephrotoxic side-effects. Sodium thiosulfate is often added to cisplatin-based hyperthermic intraperitoneal chemotherapy (HIPEC) protocols to mitigate this, however evidence regarding risk of hypernatraemia is scarce as of yet.

  Methods: We retrospectively identified patients undergoing cytoreductive surgery (CRS) for peritoneal surface malignancies of any origin at a single high-volume unit between April 2018 and December 2020. Patients were included if they received cisplatin-based HIPEC with intravenous sodium thiosulfate. Blood tests were collected pre-surgery and then daily during admission. Hypernatraemia was defined as serum sodium >145 mmol/L. Renal impairment was defined using the RIFLE criteria.

  Results: Eleven CRSs met inclusion criteria, the majority of which were indicated for ovarian cancer (72.7%). One (9.1%) patient with mesothelioma received mitomycin C as an additional chemotherapy agent. The incidence of hypernatraemia was 100% but all cases were transient, with no clinical sequelae observed. The rate of AKI was 36.4%, with three (27.3%) patients classified as risk and one (9.1%) instance of failure. No long-term renal impairment was observed.

  Conclusions: Despite biochemical evidence of mild hypernatraemia but with the absence of clinical sequelae, sodium thiosulfate appears to be safe when used in adjunct to cisplatin-based HIPEC during CRS. These findings should be evaluated with further comparative studies. When describing renal impairment, it is important that standardisation in reporting occurs, with the RIFLE and Acute Kidney Injury Network criteria now the preferred consensus definitions.

  © 2022 Anais Alonso et al., published by De Gruyter, Berlin/Boston.

• A review of malignant pleural mesothelioma in a large North East UK pleural centre. D.C. Murphy, A. Mount, F. Starkie, et al. 2020;6(1):20200144. PubMed · Publisher · Free full text

  Abstract

  Objectives: The National Mesothelioma Audit 2020 showed Northumbria to have low rates of histopathological confirmation, treatment and one-year survival rates for malignant pleural mesothelioma (MPM). We hypothesized that an internal analysis over a 10-year period provides valuable insights into presentation, diagnosis, treatment and outcomes.

  Methods: A single-centre retrospective case series of all confirmed MPM patients between 1 January 2009 and 31 December 2019 was performed. Demographics, clinical, radiological and histopathological characteristics and outcomes were collected. Statistical analysis was performed using SPSS V26.0.

  Results: A total of 247 patients had MPM. About 86% were male, mean age 75.7 years. Dyspnoea (77.4%) and chest pain (38.5%) were commonest symptoms. 64.9 and 71.4% had pleural thickening and effusion, respectively. About 86.8% had at least one attempt to obtain a tissue biopsy, but histopathological confirmation in only 108 (43.7%). About 66.3% with PS 0 and 1 (62.7% of total cohort) had at least one anti-cancer therapy. Death within 12 months was associated with disease progression within 6 months (p≤0.001). Chemotherapy (p≤0.001) and epithelioid histological subtype (p=0.01) were protective.

  Conclusions: This study confirms known epidemiology of MPM, demonstrates variability in practices and highlights how some NMA recommendations are not met. This provides the incentive for a regional mesothelioma multi-disciplinary meeting.

  © 2020 Declan C. Murphy et al., published by De Gruyter, Berlin/Boston.

• A review of the outcomes of rigid medical thoracoscopy in a large UK district general hospital. A. Aujayeb, K. Jackson. 2020;5(4):20200131. PubMed · Publisher · Free full text

  Abstract

  Objectives: Local anesthetic medical thoracoscopy (LAT) is a well-established diagnostic, therapeutic, and preventative intervention in undiagnosed pleural effusions with a high diagnostic sensitivity and low complication rates. There is a large variability in practice. We describe a nine-year experience in a large district general hospital in England.

  Methods: Two hundred seventy-five patients had LAT between January 2010 and December 2018. Data on outcomes and complications were obtained from the patients' notes, electronic records, laboratory, and radiographic findings.

  Results: The main diagnoses were malignant pleural mesothelioma (MPM) (n=110, 40%), chronic inflammation/fibrinous pleuritis (77, 28%), lung cancer (26, 9.5%), and breast cancer (16, 6%). LAT failed to diagnose cancer in 7/275 patients (false-negative rate 2.5%, diagnostic sensitivity 97.5%). Out of the 105 patients with chronic inflammation/fibrinous pleuritis or atypical proliferative processes, 21 (20%) were subsequently diagnosed with malignancy. Talcum pleurodesis was performed in 146 patients, and was successful in 86%. Seventy eight (28%) patients had trapped lung; 27 of those had a repeat procedure. The median length of stay was 3.96 days. There was one hospital death (0.3% mortality). Complications of LAT included pleural (3, 1%) and wound infections (4, 1.4%), persistent air leaks (9, 3.2%), subcutaneous emphysema (10, 3.6%), and tumor extension to the access port (1, 0.3%).

  Conclusions: In this cohort, LAT was safe, effective, and enabled high diagnostic sensitivity. Further areas of study include optimal sedation and anesthetic pathways and combining LAT with indwelling pleural catheters (IPC).

  © 2020 Avinash Aujayeb and Karl Jackson, published by De Gruyter, Berlin/Boston.

2010s

• Bidirectional chemotherapy allowing surgery and HIPEC for malignant peritoneal mesothelioma. B. Noiret, C. Eveno. 2019;4(2):20190011. PubMed · Publisher · Free full text

  Abstract

  Background: This case report aims to describe the impact of the bidirectional chemotherapy (BDC) on resecability for initially unresectable malignant peritoneal mesothelioma (MPM).

  Methods: We report a case of 55-year-old male with the diagnosis of initially unresecable MPM. The BDC combined intravenous (IV) chemotherapy (Cisplatin-Pemetrexed) and intra peritoneal (IP) chemotherapy (Cisplatin). The response to chemotherapy was assessed by CT - scan and laparoscopy.

  Results: Initial evaluation classed the disease as unresecable with PCI at 39. At the reevaluation, CT - scan and laparoscopy showed a macroscopic response, allowing surgery consisting of cytoreductive surgery and hyperthermic intra peritoneal chemotherapy (Doxorubicin and Cisplatin).

  Conclusions: BDC (IV and IP) has promising results and allows to undergo surgery for selected patients with borderline or initially unresectable MPM.

• Impact of extent of parietal peritonectomy on oncological outcome after cytoreductive surgery and HIPEC. S.P. Somashekhar, K.R. Ashwin, R. Yethadka, et al. 2019;4(4):20190015. PubMed · Publisher · Free full text

  Abstract

  Background: In peritoneal surface malignancy (PSM), in spite of optimal cytoreductive surgery (CRS), majority of recurrences that occur are intraperitoneal. In patients with PSM, studies employing fluorescent imaging and microscopic examination have shown normal looking peritoneum may harbor active disease. This study was done to assess the recurrence pattern, oncological outcomes, and morbidity and mortality of the extent of peritonectomy in patients who underwent total parietal peritonectomy (TPP) or involved field peritonectomy (IFP) as a part of the procedure during CRS and hyperthermic intraperitoneal chemotherapy (HIPEC).

  Methods: This was a retrospective analysis of prospectively collected data, from February 2013 to December 2017. A total of 163 patients with PSM underwent TPP or IFP with CRS plus HIPEC. Their oncological outcomes, recurrence pattern, postoperative morbidity and mortality were analyzed.

  Results: Of the 163 cases, the primary organs of origin were ovary, colorectal, appendicular pseudomyxoma, stomach, mesothelioma and others (67.4%, 16.5%, 6.1%, 4.9%, 2% and 2%), respectively. TPP was performed in 70 patients and IFP in 93 patients. TPP group had higher mean PCI (16 vs. 14), longer duration of surgery (11 vs. 9 h), and more blood loss (1,243 vs. 675 mL). Overall G3-G4 morbidity was comparable in both groups (42.8% vs. 33.3%) as was mortality (5.7% vs. 4.4%). Kaplan-Meier analysis showed that with a median follow-up of 45 months, TPP group had a recurrence-free survival (RFS) of 26 months and overall survival (OS) was yet to be achieved, whereas the IFP group had a RFS and OS of 21 and 43 months, respectively.

  Conclusions: Performing TPP reduces the chance of missing the microscopic disease, therefore can minimize local recurrence, and better oncological outcomes. TPP can be performed with acceptable morbidity and mortality, at the cost of increased duration of surgery and higher blood loss.

  © 2019 Somashekhar et al., published by De Gruyter.

• MESOTIP: Phase II multicenter randomized trial evaluating the association of PIPAC and systemic chemotherapy vs. systemic chemotherapy alone as 1st-line treatment of malignant peritoneal mesothelioma. O. Sgarbura, S. Gourgou, D. Tosi, et al. 2019;4(2):20190010. PubMed · Publisher · Free full text

  Abstract

  Background: Malignant peritoneal mesothelioma (MPM) is a rare tumoral disease characterized by the diffuse involvement of the peritoneal serosa. The standard frontline treatment of MPM is cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) unless the peritoneal disease is considered unresectable. For unresectable patients the standard frontline treatment is a combination of cisplatin and pemetrexed but the prognosis remains ominous with only 13 months of overall survival (OS).

  Methods: The proposed study is a multicenter randomized non-comparative study evaluating the association of Pressurized Intra-Peritoneal Aerosol Chemotherapy (PIPAC) and systemic chemotherapy vs. systemic chemotherapy alone as first-line treatment of MPM. Patients will be randomized with a 2:1 ratio using a minimization technique. Sixty-six patients have to be enrolled. Stratification will be performed according to histology (epithelioid vs. sarcomatoid and biphasic), presence of extraperitoneal disease and center. Primary objective is OS and secondary objectives include progression-free survival (PFS), safety, compliance, feasibility, conversion to resectability, histological response to treatment and quality of life.

  Conclusions: We expect to show that intensification of the first line treatment with PIPAC for initially unresectable MPM patients increases OS.

  Trial Registration: Prospective study. Clinicaltrials.gov: NCT03574493 EudraCT: 2019-001515-23.

• Multicystic peritoneal mesothelioma: a systematic review of the literature. B. Noiret, F. Renaud, G. Piessen, et al. 2019;4(3):20190024. Review PubMed · Publisher · Free full text

  Abstract

  Multicystic peritoneal mesothelioma (MCPM) is a particularly rare and benign neoplasm that arises from the peritoneum in reproductive aged females. Its etiopathogenesis is still unclear. The current prevailing theory supports the idea that the tumor is the result of an excessive inflammatory process. Because of a lack of clinical and imaging presentation, the diagnosis is intricate, and heavily relies on case reports and short studies. A histological analysis with immunohistochemistry is required for a definitive diagnosis. To date, there is no standard treatment recommended for MCPM. However, some studies suggest proceeding with a cytoreductive surgery and a hyperthermic intraperitoneal chemotherapy combining CISPLATIN and DOXORUBICIN, due to a high incidence of recurrence rate after medical treatment or surgery alone and potential malignant transformation.

  © 2019 Noiret et al., published by De Gruyter.

• Do patients undergoing cytoreductive surgery and HIPEC for peritoneal malignancy need parenteral nutrition?. D.R. Swain, A.L. Yates, F. Mohamed, et al. 2018;3(4):20180123. PubMed · Publisher · Free full text

  Abstract

  Background: To analyse the duration of parenteral nutrition (PN) in patients treated for peritoneal malignancy with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) over a 2 year period at a single UK National referral centre.

  Methods: A retrospective analysis of prospective data for all patients (n=321) who underwent CRS and HIPEC for peritoneal malignancy at the Peritoneal Malignancy Institute Basingstoke between April 1, 2013 and March 31, 2015.Duration of PN was compared between primary tumour site (appendix, colorectal, mesothelioma and other); completeness of CRS (complete CRS vs. major tumour debulking) and pre-operative nutritional assessment measures (including Mid Upper Arm Circumference).

  Results: The median duration of PN was 9 days (range 2-87 days). A total of 13 % of patients had PN for less than 7 days and 6 % for 5 days or less. There was no significant difference in duration of PN between the different tumour sites. Two factors that may increase the duration of PN include having major tumour debulking (MTD) and a baseline MUAC<23.5 cm.

  Conclusions: Most patients who underwent CRS and HIPEC for peritoneal malignancy required PN for more than 7 days with poor pre-operative nutritional status and inability to achieve complete cytoreduction predictors of prolonged PN requirements.

• Photodynamic therapy and photothermal therapy for the treatment of peritoneal metastasis: a systematic review. A. Pinto, M. Pocard. 2018;3(4):20180124. Review PubMed · Publisher · Free full text

  Abstract

  Background: The aim of this review was to analyze preclinical studies and clinical trials evaluating photodynamic therapy (PDT), and photothermal therapy (PTT) in peritoneal metastasis (PM) treatment.

  Content: Systematic review according PRISMA guidelines. Electronic searches using PubMed and Clinical Trials.

  Summary: A total of 19 preclinical studies analyzing PDT in PM treatment were included. Each new generations of photosensitizers (PS) permitted to improve tumoral targeting. Phase III preclinical studies showed an important tumoral biodistribution (ratio 9.6 vs normal tissue) and significant survival advantage (35.5 vs 52.5 days for cytoreductive surgery vs cytoreductive surgery+PDT, p<0.005). Height clinical trials showed important side effects (capillary leak syndrome and bowel perforation), mainly explained by low tumor-selectivity of the PS used (first generation mainly).Peritoneal mesothelioma apparition with carbon nanotubes first limited the development of PTT. But gold nanoparticles, with a good tolerance, permitted a limitation of tumoral growth (reduction of bioluminescence to 37 % 20 days after PTT), and survival benefit (35, 32, and 26 days for PTT with cisplatine, PTT alone and laser alone, respectively).

  Outlook: Recent improvement in tumor-selectivity and light delivery systems is promising but further development would be necessary before PDT and PTT routinely applied for peritoneal carcinomatosis.

• Practice patterns, attitudes, and knowledge among physicians regarding cytoreductive surgery and HIPEC for patients with peritoneal metastases. T. Bernaiche, E. Emery, L. Bijelic. 2018;3(1):20170025. PubMed · Publisher · Free full text

  Abstract

  Background: Cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) is a treatment option for patients with peritoneal metastases shown to provide improved overall survival for appropriately selected patients. However, the availability and utilization of this treatment remains limited. The aim of this survey-based study was to evaluate factors influencing physician treatment choices for peritoneal metastases.

  Methods: Surveys were mailed to medical oncologists and surgeons in Virginia, Maryland, and Washington, D.C. Survey questions evaluated access to HIPEC centers, prior experience with referral to HIPEC centers, opinions regarding efficacy, and knowledge regarding outcomes of CRS and HIPEC.

  Results: Surveys were mailed to 2279 physicians; 116 eligible surveys were returned. Seventy-five percent of respondents would consider referral to a HIPEC center for appendiceal peritoneal metastasis, while only 50% would consider it for colon cancer and peritoneal mesothelioma. The most common reason for never referring a patient to a HIPEC center was lack of access to a HIPEC specialist (47%) followed by perceived lack of evidence for the treatment modality (31%). Five-year survival after CRS and HIPEC was underestimated while 30-day mortality was overestimated by more than half of respondents.

  Conclusions: Referral to HIPEC centers is underutilized among community physicians in practice. Limited access to HIPEC experts is the most common cause for lack of referral, followed by a perception of insufficient evidence for this treatment approach. Lack of familiarity with data regarding outcomes impacts referral patterns and treatment choices. Possible actions to increase awareness and appropriate utilization of CRS and HIPEC are suggested.

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