Cytoreductive Surgery plus Hyperthermic Intraperitoneal Chemotherapy for Management of Peritoneal Sarcomatosis: A Preliminary Single-Center Experience from Saudi Arabia.

Ahmed Abu-Zaid,Osama Alomar,Ismail A Al-Badawi,Ayman Azzam,Tusneem Elhassan,Naryman Albadawi,Lynn Alkhatib,Tarek Amin,Mohammed Abuzaid,Abdullah Alsuhaibani

doi:10.1155/2016/6567473

Abstract

Aim. To report our preliminary single-center experience with cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) for management of peritoneal sarcomatosis (PS). Methods. Eleven patients were retrospectively analyzed for perioperative details. Results. Cytoreduction completeness (CC-0/1) was achieved in all patients with median peritoneal cancer index (PCI) of 14 ± 8.9 (range: 3–29). Combination cisplatin + doxorubicin HIPEC chemotherapy was used in 6 patients. Five patients received intraoperative radiation therapy (IORT). The median operative time, estimated blood loss, and hospital stay were 8 ± 1.4 hours (range: 6–10), 1000 ± 250 mL (range: 700–3850), and 11 ± 2.4 days (range: 7–15), respectively. Major postoperative Clavien-Dindo grade III/IV complications occurred in 1 patient and none developed HIPEC chemotherapy-related toxicities. The median overall survival (OS) and disease-free survival (DFS) after CRS + HIPEC were 28.3 ± 3.2 and 18.0 ± 4.0 months, respectively. The median follow-up time was 12 months (range: 6–33). Univariate analysis of several prognostic factors (age, gender, PS presentation/pathology, CC, PCI, HIPEC chemotherapy, and IORT) did not demonstrate statistically significant differences of OS and DFS. Conclusion. CRS + HIPEC appear to be feasible, safe, and offer survival oncological benefits. However, definitive conclusions cannot be deduced.

Highlights

Soft tissue sarcomas (STSs) are quite rare neoplasms accounting for roughly 1% of all adult solid malignancies [1]
The natural biological behavior of STSs is characterized by an increased tendency for disease dissemination [4] and recurrence [5, 6]
The aim of this study is to report our single-center experience regarding the use of cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) for management of patients with primary and recurrent peritoneal sarcomatosis (PS)

Summary

Introduction

Soft tissue sarcomas (STSs) are quite rare neoplasms accounting for roughly 1% of all adult solid malignancies [1]. The natural biological behavior of STSs is characterized by an increased tendency for disease dissemination [4] and recurrence [5, 6]. Modes of disease dissemination include local invasion, peritoneal infiltration, blood-borne, and rarely lymph-borne spread [4]. Around 35% to 82% of all STSs will experience disease recurrence after the initial surgical management [5, 6]. The vast majority of these recurred STSs (80– 90%) will progress and present as peritoneal sarcomatosis (PS)—multinodular intraperitoneal dissemination of STS [7]. This PS is especially true for abdominal/retroperitoneal STSs; trunk and limb STSs only exceptionally result in PS. It should be recognized that PS may be the primary presentation in a proportion of patients [8]

Objectives

Methods

Conclusion