What made hyperthermic intraperitoneal chemotherapy an effective curative treatment for peritoneal surface malignancy: A 25-year experience with 1,125 procedures

Our plain-English summary of What made hyperthermic intraperitoneal chemotherapy an effective curative treatment for peritoneal surface malignancy: A 25-year experience with 1,125 procedures, by G. Passot, D. Vaudoyer, L. Villeneuve, et al (Journal of Surgical Oncology, 2016).

The study

• Authors: G. Passot, D. Vaudoyer, L. Villeneuve, V. Kepenekian, A.C. Beaujard, N. Bakrin, E. Cotte, F.N. Gilly, O. Glehen
• Journal: Journal of Surgical Oncology
• Published: 2016;113(7):796-803
• Cited by: 107 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objective: To review our 25-year experience with hyperthermic intra-peritoneal chemotherapy (HIPEC).

Background: Combining cytoreductive surgery (CRS) and HIPEC as local treatments for peritoneal carcinomatosis (PC) was proposed 25 years ago.

Methods: A prospective database of all patients undergoing HIPEC for PC since 1989 was searched for clinicopathological data, 90-day morbidity and mortality, and survival.

Results: Among 1,125 HIPEC procedures, PC origin was colorectal (342; 30%), ovarian (271; 24%), pseudomyxoma peritonei (189; 17%), gastric (127; 11%), malignant mesothelioma (84; 8%), or other (112; 10%). Between 2004-2009 (n = 321) and 2010-2015 (n = 560), the median peritoneal cancer index decreased (11 vs. 8; P < 0.001), fewer patients underwent incomplete cytoreduction (CC2-3: 4% vs. 0.5%; P < 0.001), and more were included in randomized trials (5% vs. 16%; P < 0.001). Postoperative morbidity (52% vs. 50%, P = 0.672) was not different, but mortality significantly decreased (5% vs. 2%; P = 0.030). Median overall-survival was 42 months, and improved significantly for each 5-year period except for 2006-2010 vs. 2011-2015 (P = 0.097). The 10-year survival without recurrence was 53%, 14%, 4%, 10%, and 9% for pseudomyxoma, mesothelioma, ovarian, colorectal, and gastric PC, respectively.

Conclusion: This study demonstrated that CRS and HIPEC provide long-term survival irrespective of PC origin, and survival improves with experience. J. Surg. Oncol. 2016;113:796-803. © 2016 Wiley Periodicals, Inc.

© 2016 Wiley Periodicals, Inc.

In plain English

This was a review of one French surgical center's 25-year experience with cytoreductive surgery (removing visible tumor) combined with hyperthermic intraperitoneal chemotherapy, called HIPEC, which is heated chemotherapy circulated in the abdomen. The authors searched a prospective database at Lyon Sud Hospital for the 1,125 patients treated from January 1989 to September 2015 for cancer spread on the abdominal lining. Of these, 84 had malignant mesothelioma of the peritoneum. The others had colorectal, ovarian, gastric, pseudomyxoma peritonei or other cancers. The article did not examine asbestos exposure. Across all patients, median overall survival was 42 months. Survival improved significantly for each 5-year period except 2006–2010 versus 2011–2015. Death within 90 days fell from 11% before 2004 to 3% after, while major complications rose from 25% to 51%. For peritoneal mesothelioma patients, median overall survival was 119 months, 10-year overall survival 40% and 10-year disease-free survival 14%. The authors concluded the treatment became safer and gave long-term disease-free survival whatever the cancer's origin. They noted that patient selection changed over the long study period, causing selection bias.

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: Single-center review of the authors' institutional experience, using a prospective database of all patients treated with HIPEC
• Who was studied: 1,125 patients who underwent HIPEC for peritoneal carcinomatosis at Lyon Sud Hospital, France, between January 1989 and September 2015. 84 had malignant mesothelioma of the peritoneum; the rest had colorectal, ovarian, pseudomyxoma peritonei, gastric, appendiceal or other origins.
• Exposure: Not an asbestos exposure study. The treatment studied was cytoreductive surgery followed by HIPEC using cisplatin, mitomycin C, oxaliplatin, doxorubicin and/or irinotecan. No fibers, asbestos exposure or occupations are discussed.
• Main results:
  • Of the 1,125 patients, 84 (7.5%) had malignant mesothelioma of the peritoneum.
  • For all patients, the median follow-up was 31 months and the median overall survival was 42 months.
  • For all patients, median overall survival was 6.6, 16.8, 34.6 and 53.9 months, and not reached, for the periods before 1995, 1996–2000, 2001–2005, 2006–2010 and 2011–2015. It improved significantly for each period except 2006–2010 versus 2011–2015 (P = 0.097).
  • After 2004 (881 patients) compared with before 2004 (244 patients), major complications rose (51% vs. 25%; P less than 0.001), and 90-day mortality fell (3% vs. 11%; P less than 0.001).
  • Between 2004–2009 (321 patients) and 2010–2015 (560 patients), the major complication rate did not differ (52% vs. 50%; P = 0.672). Mortality was significantly lower after 2010 (2% vs. 5%; P = 0.030).
  • For the 84 patients with malignant mesothelioma of the peritoneum: median overall survival 119 months, 5-year overall survival 62%, 10-year overall survival 40%, median disease-free survival 39 months, 5-year disease-free survival 43%, 10-year disease-free survival 14%.
  • Estimated 10-year disease-free survival was 10% for colorectal, 9% for gastric, 4% for ovarian, 14% for peritoneal mesothelioma and 53% for pseudomyxoma peritonei.
• The authors' conclusion: The authors concluded that, over time, cytoreductive surgery and HIPEC became safer and gave better outcomes, with patients alive and free of disease more than 10 years after the procedure whatever the origin of the peritoneal cancer.
• Limitations the authors state:
  • The authors' definition of the 'learning period' (before 2004, when complete cytoreduction was under 80%) does not match another group's published definition.
  • The long analysis period meant patient selection changed over time, causing selection bias.
  • General medical advances over the period also improved outcomes.

Topics

Medical terms in this study, explained in our Lexicon: HIPEC, Chemotherapy, Cytoreductive Surgery, Malignant Mesothelioma, Peritoneal Cancer Index (PCI), Mesothelioma.

Related studies

• Intraperitoneal chemotherapy for peritoneal surface malignancy: experience with 1,000 patients — E.A. Levine, J.H. Stewart, et al. (2014)
• Peritoneal carcinomatosis from unusual cancer origins: Is there a role for hyperthermic intraperitoneal chemotherapy? — C. Honoré, D. Goéré, et al. (2016)
• Outcomes of repeat cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for the treatment of peritoneal surface malignancy — K.I. Votanopoulos, C. Ihemelandu, et al. (2012)
• Postoperative outcomes of laparoscopic vs open cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy for treatment of peritoneal surface malignancies — G. Passot, N. Bakrin, et al. (2014)
• Evaluation of the cost-effectiveness of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (peritonectomy) at the St George Hospital peritoneal surface malignancy program — T.C. Chua, S. Martin, et al. (2010)
• Is Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy Justified for Biphasic Variants of Peritoneal Mesothelioma? Outcomes from the Peritoneal Surface Oncology Group International Registry — K.I. Votanopoulos, P. Sugarbaker, et al. (2018)

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