Role of hyperthermic intraoperative peritoneal chemotherapy in the management of peritoneal metastases

Our plain-English summary of Role of hyperthermic intraoperative peritoneal chemotherapy in the management of peritoneal metastases, by D. Elias, D. Goéré, F. Dumont, et al (European Journal of Cancer, 2014).

The study

• Authors: D. Elias, D. Goéré, F. Dumont, C. Honoré, P. Dartigues, A. Stoclin, D. Malka, V. Boige, M. Ducreux
• Journal: European Journal of Cancer
• Published: 2014;50(2):332-40
• Type of article: Review
• Cited by: 125 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The peritoneal cavity must be oncologically considered as an organ in its own right and peritoneal metastases (PM) must be treated with the same curative intent (and the same results) as liver metastases. The package combining complete cytoreductive surgery (CCRS) (treating the visible disease) plus hyperthermic intraoperative peritoneal chemotherapy (HIPEC) (treating the remaining non-visible disease) achieves cure in many patients. Twenty years of publication allow us to assemble sufficient background information and data to point out the good and poor indications for CCRS+HIPEC. HIPEC is the standard of care for the treatment of peritoneal pseudomyxomas and peritoneal mesotheliomas and also, recently for the treatment of colorectal PM with limited peritoneal extension. HIPEC is in the evaluation phase for gastric PM and ovarian PM after initially disappointing results, but it is highly probable that it will be useful in particular settings. PM from neuroendocrine tumours are in the same situation. HIPEC is not currently indicated for the treatment of PM from sarcomas, from GIST, and for small round-cell desmoplastic tumours, given the poor results obtained. HIPEC can be useful, on a case-by-case basis, to treat rare tumours complicated by isolated peritoneal diffusion (e.g. Frantz's tumours). HIPEC can be used in the prophylactic setting to prevent PM in patients with a high risk of developing PM, and the first results of the 'second-look' approach are promising. Finally, CCRS+HIPEC appear to be indispensable tools in the oncologist's armentarium.

Copyright © 2013 Elsevier Ltd. All rights reserved.

In plain English

This article was a narrative review by specialists at Gustave Roussy in France. It covered a treatment for cancer that has spread to the lining of the abdomen (the peritoneum): surgery to remove all visible tumour, followed immediately by a heated chemotherapy bath of the abdomen during the operation (HIPEC). It did not study asbestos exposure. The authors summarised earlier published studies on several cancer types. For diffuse malignant peritoneal mesothelioma, they cited a multi-institutional registry of 405 patients treated with cytoreductive surgery. It reported a median survival of 53 months and a 5-year survival rate of 47%, and only 46% truly had complete surgery. A separate report on 211 patients from 3 referral centres gave a 5-year survival rate of 41%. For comparison, they cited a median survival of about 1 year with pemetrexed and cisplatin chemotherapy. The authors concluded that HIPEC had become the gold standard for peritoneal spread from pseudomyxomas, mesotheliomas and colorectal cancer, was still being evaluated for other tumours, and was contraindicated for some.

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 published studies on cytoreductive surgery plus HIPEC for peritoneal metastases
• Who was studied: No new patients were studied. The review drew on published series from about 20 years of literature, including registries of 2298 pseudomyxoma patients, 405 peritoneal mesothelioma patients and 523 colorectal cancer patients.
• Exposure: No asbestos exposure was studied. The subject is a treatment: complete cytoreductive surgery for visible disease, followed immediately by hyperthermic intraoperative peritoneal chemotherapy (HIPEC) for the remaining non-visible disease.
• Main results:
  • Peritoneal mesothelioma, cited multi-institutional registry of 405 patients treated with cytoreductive surgery: overall median survival of 53 months.
  • Same registry of 405 peritoneal mesothelioma patients: 5-year survival rate of 47%.
  • Same registry: only 46% truly underwent complete cytoreductive surgery, and postoperative mortality was 2%.
  • Same registry: the main prognostic factors were the completeness of surgery and the histologic subtype.
  • Peritoneal mesothelioma, cited report of 211 patients treated in 3 major referral centres: overall 5-year survival rate of 41%. That study pointed to platin performing better than mitomycin C during HIPEC.
  • Peritoneal mesothelioma treated with chemotherapy (pemetrexed and cisplatin), cited study: overall response rate of 25% and median overall survival of approximately 1 year.
  • Peritoneal pseudomyxoma, cited registry of 2298 patients treated with CCRS + HIPEC: median survival of 196 months (16 years) and a 10-year survival rate of 63%.
  • Colorectal peritoneal metastases, cited comparison of 49 patients treated with CCRS + HIPEC versus 49 treated with systemic chemotherapy only: median survival of 60 versus 24 months (p less than 0.05).
  • Cited French Registry of 1290 patients treated in 25 centres: postoperative mortality rate of 4%, and grade 3 or 4 complications in 34% of patients.
• The authors' conclusion: The authors concluded that HIPEC had become the gold standard for peritoneal metastases from pseudomyxomas, mesotheliomas and colorectal cancer. In their view it was being evaluated for gastric, ovarian and neuroendocrine tumours and was contraindicated for sarcomas, GIST and desmoplastic tumours.
• Limitations the authors state:
  • For peritoneal mesothelioma, the authors noted that the extent of disease (peritoneal cancer index) affects prognosis, but that the threshold is currently unclear.
  • The authors noted that definitive results of the Prodige 7 trial, which tested the effect of HIPEC itself in colorectal cancer, were not yet available.

Topics

Medical terms in this study, explained in our Lexicon: Chemotherapy, Peritoneal Cavity, Cytoreductive Surgery, HIPEC, Peritoneal Mesothelioma, Sarcoma, Desmoplastic Mesothelioma.

Related studies

• Conversion to Complete Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Malignant Peritoneal Mesothelioma After Bidirectional Chemotherapy — F. Le Roy, M. Gelli, et al. (2017)
• Hyperthermic intraoperative pleural cisplatin chemotherapy extends interval to recurrence and survival among low-risk patients with malignant pleural mesothelioma undergoing surgical macroscopic complete resection — D.J. Sugarbaker, R.R. Gill, et al. (2013)
• Iterative cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent peritoneal metastases — T.C. Chua, L.E. Quinn, et al. (2013)
• Peritoneal carcinomatosis from unusual cancer origins: Is there a role for hyperthermic intraperitoneal chemotherapy? — C. Honoré, D. Goéré, et al. (2016)
• 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)
• Body surface area predicts plasma oxaliplatin and pharmacokinetic advantage in hyperthermic intraoperative intraperitoneal chemotherapy — J.C. Leinwand, G.E. Bates, et al. (2013)

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