Review of a personal experience in the management of carcinomatosis and sarcomatosis

Our plain-English summary of Review of a personal experience in the management of carcinomatosis and sarcomatosis, by P.H. Sugarbaker (Japanese Journal of Clinical Oncology, 2001).

The study

• Author: P.H. Sugarbaker
• Journal: Japanese Journal of Clinical Oncology
• Published: 2001;31(12):573-83
• Type of article: Review
• Cited by: 49 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Peritoneal surface malignancy can result from seeding of gastrointestinal cancer or abdomino-pelvic sarcoma; it can also occur as a primary disease, such as peritoneal mesothelioma. In the past, this clinical situation was treated only with palliative intent.

Methods: An aggressive approach to peritoneal surface malignancy involves peritonectomy procedures, perioperative intraperitoneal chemotherapy and knowledgeable patient selection. The clinical assessments necessary for valid clinical judgements include the cancer histopathology (invasive vs expansive progression), the preoperative abdominal and pelvic CT, the peritoneal cancer index and the completeness of cytoreduction score. Proper patient selection is mandatory for optimizing the results of treatment.

Results: In a series of phase II studies, appendiceal tumors with peritoneal seeding became the paradigm for success with an 85% long-term survival in selected patients. Carcinomatosis from colon cancer had an overall 5-year survival of 50% with selected patients. Also, sarcomatosis patients overall had a 40% 5-year survival in selected patients. Peritoneal mesothelioma showed a 36% 5-year survival. In all malignancies, early aggressive treatment of minimal peritoneal surface dissemination showed the greatest benefit.

Conclusions: Oncologists must accept responsibility for knowledgeable management of peritoneal surface dissemination of cancer because a curative approach has been demonstrated in large phase II studies and all historical controls show 0% long-term survival. Adjuvant phase III studies with perioperative intraperitoneal chemotherapy in diseases where peritoneal surface spread occurs are indicated.

In plain English

This was a review in which a Washington Cancer Institute surgeon described the group's experience treating cancer on the abdominal lining (peritoneal surface malignancy). This included spread from appendix cancer, colon cancer and abdomino-pelvic sarcoma, and also peritoneal mesothelioma, which the article describes as a primary disease of that lining. The article did not discuss asbestos or what caused these cancers. Treatment combined surgery to remove visible tumor (peritonectomy) with chemotherapy placed in the abdomen, heated during the operation and sometimes continued for five days afterward. The review summarized the group's earlier studies. In selected patients treated for sarcomatosis, 5-year survival was 75% when the peritoneal cancer index score was below 13, and 13% when it was 13 or higher. Among 200 consecutive treated patients, there were three treatment-related deaths (printed as 1.8%), and 25.3% had grade III or IV complications. The abstract reported 36% 5-year survival for peritoneal mesothelioma; the main text gave no detail on it. The author concluded that a curative approach had been demonstrated in large phase II studies and that phase III studies were indicated.

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: Narrative review of the author's group's own treatment methods and earlier phase II studies (not a new study)
• Who was studied: Patients with peritoneal surface malignancy treated by the author's group, as described in earlier reports. These included nearly 600 patients with appendiceal malignancy over 20 years and about 150 with peritoneal carcinomatosis from colon cancer. They also included selected sarcomatosis patients (27 with complete and 16 with incomplete cytoreduction) and 200 consecutive patients in a morbidity and mortality report. The article gives no patient numbers for peritoneal mesothelioma, which it describes as a primary peritoneal disease.
• Exposure: No asbestos or other cause of disease was studied. The subject was a treatment: peritonectomy procedures plus perioperative intraperitoneal chemotherapy. Drugs included mitomycin C and 5-fluorouracil, and for mesothelioma cisplatin, doxorubicin and paclitaxel. The intraoperative chemotherapy was heated (intraperitoneal fluid at 41–42°C for 90 min).
• Main results:
  • Selected patients treated for sarcomatosis (Berthet et al., the author's group; figures describe recurrent abdomino-pelvic sarcoma): 5-year survival was 75% with a peritoneal cancer index below 13 and 13% with an index of 13 or more.
  • Selected sarcomatosis patients: 27 patients with complete cytoreduction had a 5-year survival rate of 39%, and 16 patients with CC-2 or CC-3 resection had a survival rate of 14%.
  • Patients with intestinal obstruction after prior gastrointestinal cancer (Averbach and Sugarbaker): complete cytoreduction was followed by 5-year survival in 60%, and incomplete resection by no 5-year survivors.
  • Appendiceal malignancy: survival was significantly correlated with the invasive character of the mucinous tumor and with completeness of cytoreduction.
  • Colon cancer with carcinomatosis: the author previously reported 50% survival in patients with a peritoneal cancer index of 10 or less.
  • In 200 consecutive patients given cytoreductive surgery and heated intraoperative intraperitoneal chemotherapy, there were three treatment-related deaths (printed as 1.8%). The most common major complications were peripancreatitis (7.1%) and fistula (4.7%), and 25.3% had grade III or IV complications.
  • Peritoneal mesothelioma: the article's printed abstract reports a 36% 5-year survival. The main text gives no patient numbers or other detail for this figure.
• The authors' conclusion: The author concluded that oncologists must accept responsibility for managing peritoneal surface spread of cancer, because a curative approach had been demonstrated in large phase II studies and historical controls showed 0% long-term survival. The author also concluded that adjuvant phase III studies were indicated.

Topics

Medical terms in this study, explained in our Lexicon: Sarcoma, Peritoneal Mesothelioma, Palliative Care, Chemotherapy, Histopathology, Peritoneal Cancer Index (PCI), Cytoreductive Surgery, Colorectal Cancer.

Related studies

• Toxicity of hyperthermic intraperitoneal chemotherapy (HIPEC) in pediatric patients with sarcomatosis/carcinomatosis: early experience and phase 1 results — A. Hayes-Jordan, H. Green, et al. (2012)
• Multicenter comprehensive methodological and technical analysis of 832 pressurized intraperitoneal aerosol chemotherapy (PIPAC) interventions performed in 349 patients for peritoneal carcinomatosis treatment: An international survey study — M. Nowacki, M. Alyami, et al. (2018)
• Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis: the Danish experience — L.H. Iversen, P.C. Rasmussen, et al. (2013)
• Repeat Cytoreductive Surgery and HIPEC for Peritoneal Surface Malignancy and Peritoneal Carcinomatosis — J.F. Wong, G.H. Tan, et al. (2015)
• Quality of life of patients with end-stage peritoneal metastasis treated with Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) — K. Odendahl, W. Solass, et al. (2015)
• Evolution of locoregional treatment for peritoneal carcinomatosis: single-center experience of 308 procedures of cytoreductive surgery and perioperative intraperitoneal chemotherapy — T.C. Chua, W. Liauw, et al. (2011)

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