Peritoneal carcinomatosis from unusual cancer origins: Is there a role for hyperthermic intraperitoneal chemotherapy?

Our plain-English summary of Peritoneal carcinomatosis from unusual cancer origins: Is there a role for hyperthermic intraperitoneal chemotherapy?, by C. Honoré, D. Goéré, R. Macovei, et al (Journal of Visceral Surgery, 2016).

The study

• Authors: C. Honoré, D. Goéré, R. Macovei, L. Colace, L. Benhaim, D. Elias
• Journal: Journal of Visceral Surgery
• Published: 2016;153(2):101-7
• Cited by: 23 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Introduction: Complete cytoreductive surgery (CCRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) is the gold standard for curative treatment of peritoneal carcinomatosis (PC) arising from colorectal cancer, peritoneal mesothelioma and peritoneal pseudomyxoma peritonei (PMP). The results of HIPEC remain controversial in PC that originates from ovarian cancer, stomach cancer, neuroendocrine tumors, or sarcoma. HIPEC has also been used, although very rarely, for other malignant carcinomatoses. Its use has been exceptional due either to the rarity of the tumor or because such disease is usually widespread and rarely confined to the peritoneum. The aim of this study was to evaluate the results of CCRS plus HIPEC in patients with PC of unusual origin.

Methods: We performed a retrospective analysis of all patients who underwent CCRS plus HIPEC for PC whose origin was neither gastric, ovarian or colorectal carcinoma, nor neuroendocrine tumor, mesothelioma, PMP or sarcoma.

Results: Between 1995 and 2013, 31 patients with 15 PC arising from unusual primary tumors underwent CCRS plus HIPEC. After a median follow-up of 90 months, 10 patients were alive and without recurrence. The overall survival rate at 5 years was 33% with a median survival of 37 months. In univariate analysis, factors of poor prognosis and predictors of recurrence were the performance of immediate postoperative intraperitoneal chemotherapy instead of HIPEC and a peritoneal index ≥ 12. No prognostic impact due to tumor origin could be demonstrated.

Conclusion: The decision to perform CCRS plus HIPEC for PC arising from unusual cancer origins remains difficult. These patients should be prospectively entered into registries of rare tumors that involve the peritoneum in order to better define indications.

Copyright © 2015 Elsevier Masson SAS. All rights reserved.

In plain English

This study, from the Gustave-Roussy cancer center in Villejuif, France, looked back at patients whose cancer had spread across the lining of the abdomen (peritoneal carcinomatosis) from unusual origins. All were treated with complete surgery to remove the tumor plus chemotherapy delivered into the abdomen. Peritoneal mesothelioma was deliberately excluded, and the article does not discuss asbestos. Between 1995 and 2013, 31 patients (18 women and 13 men, median age 37) with 15 different tumor types were treated. Surgery left no visible tumor, or only tiny remnants, in every patient. Twenty received heated chemotherapy during surgery (HIPEC), and 11 instead received chemotherapy right after surgery. Complications occurred in 48%, and there were no deaths in the postoperative period. After a median follow-up of 90 months, 10 patients (32%) were alive without recurrence. Five-year survival was 33%, and median survival was 37 months. In univariate analysis, receiving HIPEC rather than post-operative chemotherapy, and a peritoneal index less than 12, were linked to better survival. The authors said their analysis could not define the effect of tumor origin. They concluded that the decision to use this treatment remains difficult.

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 analysis of consecutive patients at one center, using data from a prospective data collection system
• Who was studied: 31 patients (18 women, 13 men; median age 37, range 10 to 61) treated at Gustave-Roussy cancer center, Villejuif, France, between 1995 and 2013. They had peritoneal carcinomatosis from 15 unusual origins. Colorectal, gastric and ovarian carcinoma, neuroendocrine tumor, pseudomyxoma peritonei, mesothelioma and sarcoma were excluded. These patients were 3.5% of all patients treated with HIPEC at the center in that period.
• Exposure: No asbestos or fiber exposure was studied. The treatment studied was complete cytoreductive surgery plus intraperitoneal chemotherapy, given either as open-abdomen HIPEC (20 patients) or as immediate postoperative intraperitoneal chemotherapy (IPIPC, 11 patients). The authors report that 95% of HIPEC consisted of oxaliplatin with or without irinotecan.
• Main results:
  • Cytoreductive surgery was complete in all 31 patients (CC-0 in 97%, CC-1 in 3%).
  • Postoperative morbidity was 48%, and no patient died postoperatively. Deaths did occur during later follow-up, as shown in the article's Table 1.
  • After a median follow-up of 90 months, 10 of the 31 patients (32%) were alive without recurrence. Among the 21 patients with recurrence, 81% had peritoneal recurrence.
  • For the whole group, overall 5-year survival was 33% and median survival was 37 months.
  • In univariate analysis, positive prognostic factors were open-abdomen HIPEC versus IPIPC (P = 0.002) and a peritoneal index less than 12 (P = 0.011). Factors predicting recurrence were IPIPC versus HIPEC (P = 0.049) and a peritoneal index greater than 12 (P = 0.048). No predictor of peritoneal recurrence was identified.
  • The authors stated that their retrospective analysis did not allow them to define the impact of the tumor's cellular origin on long-term results.
• The authors' conclusion: The authors concluded that the decision to perform this treatment for peritoneal carcinomatosis from unusual cancers remains difficult. They said it must rest on several factors, including age, general condition, the likelihood of complete surgery, absence of spread outside the peritoneum, tumor origin and the peritoneal index. They suggested that prospective registration in rare peritoneal tumor registries could better define indications.
• Limitations the authors state:
  • The authors state that the study has the classic biases of retrospective studies on rare tumors.
  • The authors state that patients were selected, so the results apply only to such selected patients.
  • The authors state that, because these cancers are so rare, they could not show whether disease outside the peritoneum affected prognosis.

Topics

Medical terms in this study, explained in our Lexicon: HIPEC, Cytoreductive Surgery, Colorectal Cancer, Peritoneal Mesothelioma, Ovarian Cancer, Stomach Cancer, Sarcoma, Peritoneum.

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• Preoperative Thrombocytosis Predicts Shortened Survival in Patients with Malignant Peritoneal Mesothelioma Undergoing Operative Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy — Y.C. Li, T. Khashab, et al. (2017)
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