Abstract
BackgroundPeritoneal metastasis (PM) is considered a terminal and incurable disease. In the last 30 years, cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) radically changed the therapeutic approach for these patients and is regarded as the standard of care for pseudomyxoma peritonei from appendiceal cancer and peritoneal mesotheliomas. Improved survival has also been reported in treating PM from ovarian, gastric, and colorectal cancers.However, PM often seriously complicates the clinical course of patients with other primary digestive and non-digestive cancers. There is increasing literature evidence that helped to identify not only the primary tumors for which CRS and HIPEC showed a survival advantage but also the patients who may benefit form this treatment modality for the potential lethal complications.Our goal is to report our experience with cytoreduction and HIPEC in patients with PM from rare or unusual primary tumors, discussing possible “unconventional” indications, outcome, and the peculiar issues related to each tumor.MethodsFrom a series of 253 consecutive patients with a diagnosis of peritoneal carcinomatosis and treated by CRS and HIPEC, we selected only those with secondary peritoneal carcinomatosis from rare or unusual primary tumors, excluding pseudomyxoma peritonei, peritoneal mesotheliomas, ovarian, gastric, and colorectal cancers. Complications and adverse effects were graded from 0 to 5 according to the WHO Common Toxicity Criteria for Adverse Events (CTCAE). Survival was expressed as mean and median.ResultsWe admitted and treated by CRS and HIPEC 28 patients with secondary peritoneal carcinomatosis from rare or unusual primary tumors. Morbidity and mortality rates were in line with those reported for similar procedures. Median survival for the study group was 56 months, and 5-year overall survival reached 40.3 %, with a difference between patients with no (CC0) and minimal (CC1) residual disease (52.3 vs. 25.7), not reaching statistical significance. Ten patients are alive disease-free, and eight are alive with disease.ConclusionsCytoreduction and HIPEC should not be excluded “a priori” for the treatment of peritoneal metastases from unconventional primary tumors. This combined therapeutic approach, performed in an experienced center, is safe and can provide a survival benefit over conventional palliative treatments.
Highlights
Peritoneal metastasis (PM) is considered a terminal and incurable disease
Our goal is to report our single-institution experience with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with PM from rare or unusual primary tumors, discussing possible indications, outcomes, and the peculiar issues related to each tumor, hoping to contribute to extend the actual knowledge on the treatment of PM by this combined treatment
From the clinical records of a series of 253 consecutive patients admitted in our Institution from November 2000 to December 2013 with a diagnosis of peritoneal carcinomatosis from various primary tumors and treated by maximal cytoreduction and HIPEC, we considered for this study only the patients with a diagnosis of secondary peritoneal carcinomatosis from “unconventional” primary tumors
Summary
In the last 30 years, cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) radically changed the therapeutic approach for these patients and is regarded as the standard of care for pseudomyxoma peritonei from appendiceal cancer and peritoneal mesotheliomas. Over the past two decades, a novel therapeutic approach has emerged, combining cytoreductive surgery (CRS), performed to treat all visible disease, and hyperthermic intraperitoneal chemotherapy (HIPEC) used to treat microscopic residual disease [7, 8] This treatment radically changed the therapeutic approach for patients with peritoneal surface malignancies and is nowadays regarded as the standard of care for pseudomyxoma peritonei from appendiceal cancer and peritoneal mesotheliomas [9, 10]. In the last two decades, many studies reported with this combined approach improved survival for the treatment of peritoneal metastases from ovarian [11,12,13], gastric [14, 15], and colorectal cancers [16,17,18]
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