Peritoneal cancer treatment

Our plain-English summary of Peritoneal cancer treatment, by Y. Yonemura, E. Canbay, Y. Endou, et al (Expert Opinion on Pharmacotherapy, 2014).

The study

• Authors: Y. Yonemura, E. Canbay, Y. Endou, H. Ishibashi, A. Mizumoto, M. Miura, Y. Li, Y. Liu, K. Takeshita, M. Ichinose, N. Takao, M. Hirano, S. Sako, G. Tsukiyama
• Journal: Expert Opinion on Pharmacotherapy
• Published: 2014;15(5):623-36
• Type of article: Review
• Cited by: 35 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Introduction: In the past, peritoneal surface malignancy (PSM) was considered as a final stage of cancer, and patients were offered the best supportive care. Recently, a new therapeutic alternative approach based on the combination of surgery with chemotherapy was developed. In this curative intent, the macroscopic disease was treated with cytoreductive surgery (CRS) combined with perioperative chemotherapy, including neoadjuvant chemotherapy, hyperthermic intraoperative intraperitoneal chemotherapy, extensive intraoperative peritoneal lavage and early postoperative intraperitoneal chemotherapy

Areas Covered: This article reviews the mechanisms of the formation of PSM, quantitative estimation of PSM and residual disease, multimodal treatment, value of laparoscopy, prognostic factors and patients' selection for the multimodal therapy.

Expert Opinion: Recent studies show that CRS plus intraperitoneal chemotherapy applications confer prolonged survival in patients with PSM from colorectal, gastric, ovarian, appendiceal mucinous carcinoma and diffuse malignant peritoneal mesothelioma. The comprehensive treatment is now justified as state-of-the-art for patients with peritoneal metastasis.

In plain English

This article was a review, not a new study. The authors reviewed published work on cancer spread across the lining of the abdomen (peritoneal surface malignancy) from colorectal, gastric, ovarian and appendiceal mucinous cancers and from diffuse malignant peritoneal mesothelioma. They covered how such spread forms, scoring of tumor extent and leftover tumor, surgery to remove all visible tumor (cytoreductive surgery) combined with chemotherapy given into the abdomen, including heated chemotherapy during surgery (HIPEC), laparoscopy, prognostic factors and complications. The article did not discuss asbestos. For diffuse malignant peritoneal mesothelioma, the review cited earlier studies that linked poorer survival to factors including male sex, age older than 53, sarcomatoid or biphasic tumor type and incomplete tumor removal. It also cited an earlier study of 10 such patients, treated with surgery, HIPEC and added chemotherapy, whose median survival was 33.5 months. Cited reports put death rates after surgery plus HIPEC at 0.9 to 5.8%. The authors concluded that the combined treatment is justified as state-of-the-art. They noted that most earlier studies were Phase II and that HIPEC protocols varied.

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: Review of published literature (no new patients studied)
• Who was studied: No new population. The review covered published reports on patients with peritoneal surface malignancy from colorectal cancer, gastric cancer, appendiceal mucinous carcinoma, diffuse malignant peritoneal mesothelioma and ovarian cancer.
• Exposure: Not an exposure study. The article does not mention asbestos or any fiber type. The topics reviewed were treatments: cytoreductive surgery with perioperative intraperitoneal chemotherapy (neoadjuvant chemotherapy, HIPEC, extensive intraoperative peritoneal lavage, early postoperative intraperitoneal chemotherapy) and laparoscopy.
• Main results:
  • In diffuse malignant peritoneal mesothelioma, cited studies related these factors, among others, to poor survival: male sex, age older than 53, weight loss, non-incidental diagnosis, peritoneal cancer index higher than 28, sarcomatoid/biphasic histology, and incomplete cytoreduction (CC-score 3 or 2).
  • Two cited studies (Yan et al. and Cerruto et al.) found in multivariate analysis that nuclear size was the only independent prognostic factor for overall survival in diffuse malignant peritoneal mesothelioma.
  • A cited Phase II study by Bijelic et al. gave intraperitoneal pemetrexed with intravenous cisplatin to 10 patients with diffuse malignant peritoneal mesothelioma undergoing cytoreductive surgery and HIPEC. Median survival of all 10 patients was 33.5 months.
  • The review cited a suggestion that cytoreductive surgery plus HIPEC be the standard of care for peritoneal metastasis from appendiceal mucinous carcinoma and diffuse malignant peritoneal mesothelioma.
  • In cited reports, mortality after cytoreductive surgery and HIPEC ranged from 0.9 to 5.8%. A cited systematic review (Chua et al.) found major morbidity rates of 12 to 52%.
• The authors' conclusion: The authors concluded that cytoreductive surgery plus perioperative intraperitoneal chemotherapy is justified as a state-of-the-art treatment to improve long-term survival of patients with peritoneal surface malignancy. They said it is performed with curative intent for a subset of patients whose peritoneal cancer index is below the threshold for each disease.
• Limitations the authors state:
  • Most of the studies reviewed were Phase II; Phase III studies were lacking before 2002.
  • Some clinical data came from empirical schemes rather than systematic experimental studies, and HIPEC temperatures and exposure times varied between reports.
  • There was little consistency in protocols across the HIPEC clinical trials.

Topics

Medical terms in this study, explained in our Lexicon: Chemotherapy, Cytoreductive Surgery, Neoadjuvant Chemotherapy, Multimodal Therapy, Carcinoma, Peritoneal Mesothelioma, Metastasis.

Related studies

• Laparoscopic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for limited peritoneal metastasis. The PSOGI international collaborative registry — A. Arjona-Sanchez, O. Aziz, et al. (2021)
• What made hyperthermic intraperitoneal chemotherapy an effective curative treatment for peritoneal surface malignancy: A 25-year experience with 1,125 procedures — G. Passot, D. Vaudoyer, et al. (2016)
• Surgical treatment of peritoneal carcinomatosis: current treatment modalities — Y. Kulu, B. Müller-Stich, et al. (2014)
• Peritoneal cystic mesothelioma: are surgery and HIPEC optimal first-line treatments? — F. Coccolini, R. Manfredi, et al. (2012)
• Recurrence of Optimally Treated Malignant Peritoneal Mesothelioma with Cytoreduction and Heated Intraperitoneal Chemotherapy — D.R. Heller, C. Chiuzan, et al. (2017)
• Outcomes of repeat cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for the treatment of peritoneal surface malignancy — K.I. Votanopoulos, C. Ihemelandu, et al. (2012)

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