Update of randomized controlled trials evaluating cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in prevention and therapy of peritoneal metastasis: a systematic review.

Barbara Noiret,Guillaume Piessen,Clarisse Eveno

doi:10.1515/pp-2021-0152

Barbara Noiret, Guillaume Piessen + Show 1 more

Open Access

https://doi.org/10.1515/pp-2021-0152

Copy DOI

Journal: Pleura and Peritoneum	Publication Date: Mar 15, 2022
Citations: 6	License type: CC BY 4.0

Affiliation: Hôpital Claude Huriez

Abstract

BackgroundCytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is associated with favorable short- and long-term oncological outcomes in highly selected patients with peritoneal metastasis (PM). The aim of our review was to review published, recruiting or ongoing randomized controlled trials (RCTs) evaluating CRS and HIPEC vs. other strategies (systemic chemotherapy or CRS alone) and to update the studies recently described in 2016.ContentSystematic review according to PRISMA guidelines. Searches for published and ongoing trials were based, respectively, on PubMed and international clinical databases since 2016.Summary46 trials randomized 9,063 patients: 13 in colorectal cancer (3 in therapeutic strategy and 10 in prophylactic strategy), 16 in gastric cancer (4 in therapeutic strategy and 12 in prophylactic strategy) and 17 in ovarian cancer (12 in front-line therapy and 5 in recurrence settings).OutlookIn contrast to many recruiting studies, few published studies analyzed the potential advantage of CRS and HIPEC in therapeutic and prophylactic treatment of PM. The potential effect of this combined treatment has been proven in ovarian cancer in interval surgery, but remains still debated in other situations. Promising trials are currently recruiting to provide further evidence of the effectiveness of CRS and HIPEC.

Highlights

IntroductionPeritoneal metastasis (PM) is defined as peritoneal metastases of pre-existing cancers (mostly digestive or gynecological cancers) or as primary peritoneal malignancies such as malignant peritoneal mesothelioma (MPM) or pseudomyxoma peritonei (PMP)
Peritoneal metastasis (PM) is defined as peritoneal metastases of pre-existing cancers or as primary peritoneal malignancies such as malignant peritoneal mesothelioma (MPM) or pseudomyxoma peritonei (PMP)
Results of randomized controlled trials (RCTs) concerning Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal metastasis (PM) are presented by organ

Summary

Introduction

Peritoneal metastasis (PM) is defined as peritoneal metastases of pre-existing cancers (mostly digestive or gynecological cancers) or as primary peritoneal malignancies such as malignant peritoneal mesothelioma (MPM) or pseudomyxoma peritonei (PMP). Treatment combining cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has a key role in the management of all PM in highly selected patients. Several studies have widely demonstrated the benefit survival of the combined treatment in gastric cancer [1], ovarian cancer [2], appendiceal cancer and PMP [3, 4] or MPM [4]. Several randomized clinical trials (RCTs) were recently published or are currently ongoing evaluating the contribution of CRS and HIPEC compared to other therapeutic approaches in PM. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is associated with favorable short- and long-term oncological outcomes in highly selected patients with peritoneal metastasis (PM). The aim of our review was to review published, recruiting or ongoing randomized controlled trials (RCTs) evaluating CRS and HIPEC vs other strategies (systemic chemotherapy or CRS alone) and to update the studies recently described in 2016. Outlook: In contrast to many recruiting studies, few published studies analyzed the potential advantage of CRS and HIPEC in therapeutic and prophylactic treatment of PM

Objectives

Results

Conclusion