Safe performance of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients with HIV infection

Our plain-English summary of Safe performance of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients with HIV infection, by A. Coghill, J. Sanchez, S. Sinha, et al (Cancer Reports, 2022).

The study

• Authors: A. Coghill, J. Sanchez, S. Sinha, J.B. Permuth, D. Laskowitz, B.D. Powers, S.P. Dineen
• Journal: Cancer Reports
• Published: 2022;5(10):e1667
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Patients with HIV (PHIV) are living longer with the adoption of anti-retroviral therapy. As such, more patients are presenting with advanced cancer diagnoses, including peritoneal surface malignancies. The objective of this study was to assess the safety of CRS/HIPEC in this cohort of patients.

Case: Five PHIV were identified, four of whom underwent CRS/HIPEC. Primary sites of disease were low-grade appendiceal mucinous tumors in three patients and peritoneal mesothelioma in the other. Operative time ranged from 7 to 14 h. One patient developed a Clavien grade II complication postoperatively. There was no instance of neutropenia identified. One patient died of disease 19 months after surgery; the remaining three patients are alive 11, 21, and 33 months postoperatively.

Conclusion: This study demonstrates that CRS/HIPEC can be performed in PHIV without prohibitive complications and operative recovery approximates that of non-HIV patients. Though more study is needed, HIV should not preclude a patient from being offered CRS/HIPEC.

© 2022 The Authors. Cancer Reports published by Wiley Periodicals LLC.

In plain English

This case series from Moffitt Cancer Center in Florida described people with HIV given cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). The operation removes visible tumor, then bathes the abdomen in heated chemotherapy. Five patients with HIV were evaluated between August 2018 and May 2020. In one, the operation was stopped without HIPEC. The four treated were three men and one woman, aged 49 to 62. Three had low-grade appendiceal tumors and one had peritoneal mesothelioma. The article did not discuss asbestos. Operations lasted 7 to 14 hours; hospital stays, 8 to 12 days. One patient had bilateral venous thromboembolism, a Clavien grade II complication. None was readmitted within 30 days, and none had recorded neutropenia (neutrophil count below 1500) within 30 days after surgery. One died 19 months after surgery as appendiceal cancer progressed; the authors said this death was not related to HIV. The other three were alive at 11, 21 and 33 months. The authors concluded that the procedure can be performed safely in people with HIV. They noted the series had only four patients, too few for statistical comparisons.

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: Case series (retrospective review of institutional records)
• Who was studied: Five patients with HIV were evaluated for CRS/HIPEC at Moffitt Cancer Center, Florida, between August 2018 and May 2020. Four underwent CRS/HIPEC: three males and one female, aged 49 to 62 years. Three of the four had low-grade appendiceal tumors and one had peritoneal mesothelioma.
• Exposure: The study examined a treatment, not asbestos exposure: cytoreductive surgery with hyperthermic intraperitoneal chemotherapy using mitomycin C (30 mg at the start and 10 mg more after 60 minutes) in patients with HIV. The article does not mention asbestos exposure.
• Main results:
  • Of the five patients with HIV who were evaluated, one had disease that could not be completely removed, and that procedure was stopped without HIPEC.
  • Among the four treated patients, three had low-grade appendiceal tumors and one had peritoneal mesothelioma.
  • The mesothelioma patient had previously had surgery (CRS without HIPEC).
  • Operative time for the four patients ranged from 7 to 14 hours. Two appendiceal cancer patients, with Peritoneal Cancer Index scores of 28 and 38, had incomplete cytoreduction (CC 2).
  • Postoperative hospital stay ranged from 8 to 12 days. One patient developed bilateral venous thromboembolism, a Clavien grade II complication.
  • Among the four patients there were no 30-day readmissions. No post-operative neutropenia was recorded, with neutropenia defined as an absolute neutrophil count below 1500 within 30 days of CRS/HIPEC.
  • Before surgery, HIV RNA was undetectable in three patients and below 20 copies/ml in one. One patient had a temporary rise in viral load at 5 months, and it was undetectable again by 10 months.
  • One patient's CD4+ T-cell count fell from 642 before therapy to below 200 within 1 month of surgery.
  • Three of the four patients were alive at 11, 21 and 33 months after surgery. One patient with progressing low-grade mucinous adenocarcinoma died 19 months after surgery, and the authors stated this death was not related to HIV.
• The authors' conclusion: The authors concluded that, although the report includes only four patients, it adds to the understanding that CRS/HIPEC can be performed safely in people with HIV. They also stated that their data support including such patients in standard treatment.
• Limitations the authors state:
  • The small number of patients prevented statistical comparison with national cohort studies.
  • CD4+ T-cell counts were not consistently available in the medical record before surgery.
  • One patient had been followed for less than a year and had no updated CD4+ T-cell count.

Topics

Medical terms in this study, explained in our Lexicon: Cytoreductive Surgery, HIPEC, Peritoneal Mesothelioma, Neutropenia.

Related studies

• Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) in a patient with peritoneal mesothelioma and HIV infection — M.R. Balestra, D. Baratti, et al. (2010)
• A Canadian single-centre experience with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for abdominal malignancies — R. Nassabein, R. Younan, et al. (2022)
• Assessing morbidity, mortality, and survival in patients with peritoneal carcinomatosis undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy — J.S.A. Vallejo, F.L. Queiroz, et al. (2023)
• Phase II Trial of Adjuvant Dendritic Cell Vaccine in Combination with Celecoxib, Interferon-α, and Rintatolimod in Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Metastases — R. Ramanathan, H. Choudry, et al. (2021)
• Adjuvant dendritic cell-based immunotherapy after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients with malignant peritoneal mesothelioma: a phase II clinical trial — M.V. Dietz, K.L.A. Quintelier, et al. (2023)
• The results of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in 1200 patients with peritoneal malignancy — B. Moran, T. Cecil, et al. (2015)

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