Abstract
Cytoreductive surgery plus hypertermic intraperitoneal chemotherapy has emerged as a major comprehensive treatment of peritoneal malignancies and is currently the standard of care for appendiceal epithelial neoplasms and pseudomyxoma peritonei syndrome as well as malignant peritoneal mesothelioma. Unfortunately, there are some worldwide variations of the cytoreductive surgery and hypertermic intraperitoneal chemotherapy techniques since no single technique has so far demonstrated its superiority over the others. Therefore, standardization of practices might enhance better comparisons between outcomes. In these settings, the Brazilian Society of Surgical Oncology considered it important to present a proposal for standardizing cytoreductive surgery plus hypertermic intraperitoneal chemotherapy procedures in Brazil, with a special focus on producing homogeneous data for the developing Brazilian register for peritoneal surface malignancies.
Highlights
Cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) has emerged as a major comprehensive treatment of peritoneal surface malignancies, especially for malignancies that remain confined to the abdominopelvic cavity with little invasion of the underlying organs and no metastatic spread[1]
For Pseudomyxoma peritonei (PMP) and appendiceal tumors, the suggested protocols are (1) oxaliplatin 360mg/m2 for 30min or (2) cisplatin 100mg/m2 plus doxorubicin 15mg/m2 for 60min, both at 4L of perfusate[56]. These drug dosages should be reduced by about 30% for patients over the age of 60-70 years, patients previously exposed to multiple lines of systemic chemotherapy, patients who needed GM-CSF rescue for febrile neutropenia while on systemic chemotherapy, patients who have received radiation therapy to bone-marrow bearing regions, and those who underwent extensive surgical cytoreduction due to high peritoneal cancer index (PCI) scores[88,89]
The largest published data involving more than two thousand patients with PMP/appendiceal tumors treated by strategies of CRS/HIPEC in 16 specialized centers had demonstrated no significant benefit in terms of overall survival for HIPEC with Oxaliplatin vs. MMC (10y survival of 78% vs. 66%, respectively; differences not statistically significant)[4]
Summary
Cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) has emerged as a major comprehensive treatment of peritoneal surface malignancies, especially for malignancies that remain confined to the abdominopelvic cavity with little invasion of the underlying organs and no metastatic spread[1]. CRS/HIPEC continued to gain interest throughout the country and several reports of initial or consolidated experiences have shown the efficacy of this treatment in Brazil[15,16,17,18,19,20,21,22,23,24,25,26,27,28,29] These data are heterogeneous in terms of technical particularities and antimitotic agents, but this combined therapeutic approach has been performed with acceptable morbimorbidity and mortality and appears to provide a survival benefit over conventional treatments in many of our centers. We considered it important to present a statement produced by BSSO in order to guide the current clinical practice concerning CRS/HIPEC procedures in Brazil, with a special focus on producing homogeneous data for the developing Brazilian register for peritoneal surface malignancies
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