Regional Therapies for Advanced Cancer

Abstract

potentiating factor for responses to ILI versus limb perfusions, but measurement of the degree of hypoxia is poorly reported. By using optical spectroscopy, tumor hypoxia was measured as being more profound than in the normal skin of patients undergoing ILI. This technique could help noninvasively examine the tissue microenvironment and provide clues to the effectiveness of therapies. Lohani et al. 3 present their research examining the microenvironment regarding patients with the pseudomyxoma peritonei syndrome; their work examines cytokines in the serum and ascites. They also attempt to correlate these levels with the stroma and tumor cells. While C-reactive protein is elevated in patients with pseudomyxoma peritonei, traditional inflammatory markers such as IL-1 were not elevated. This work supports a complex model of inflammation and neoplasia demonstrating the peritoneal synthesis of cytokines and serum elevations of IL-8 and MIP-1b. While understanding that tumor‐host microenvironments are important in advancing the field, the direct impact of these interactions is seen in patients who undergo regional therapies. The next articles demonstrate the delicate balance between aggressiveness of disease, genetics, and histology in predicting response to therapy. Magge et al. 4 tackle a difficult problem in evaluating the role of cytoreductive surgery and HIPEC in the management of patients with gastric cancer and peritoneal carcinomatosis. Close on the heels of a recently published randomized trial, this study demonstrates the survival benefit in selected patients with gastric cancer in a Western population. 5 Despite aggressive surgical techniques and careful selection of patients with minimal peritoneal disease [median peritoneal carcinomatosis index (PCI) = 10], the 3-year survival in this cohort was a humbling 18 %. The group identified characteristics such as male gender, signet ring histology, incomplete cytoreduction, and multivisceral surgery as factors predicting either worse survival or progression of disease.