Debulking Research Articles

Research progress of immune checkpoint inhibitors in ovarian cancer

Ovarian cancer is the deadliest malignant tumor in the female reproductive system. Despite advancements in standard treatments such as tumor debulking surgery and platinum-based chemotherapy, the overall survival rate remains low. The emergence of targeted therapies, including Poly(ADP-ribose) polymerase (PARP) inhibitors and anti-angiogenic agents, has provided new avenues for treatment. However, drug resistance and disease heterogeneity continue to pose significant challenges. Immune checkpoint inhibitors (ICIs), as an emerging therapeutic approach, primarily target the programmed cell death protein 1 (PD-1)/programmed cell death ligand 1 (PD-L1) and cytotoxic T-lymphocyte antigen 4 (CTLA-4) pathways to restore anti-tumor immune responses. Although ICIs have shown significant efficacy in other malignancies, their effectiveness in ovarian cancer is limited, with a response rate of only 10–15% for monotherapy. Recent studies have focused on combining ICIs with chemotherapy, anti-angiogenic agents, or PARP inhibitors to enhance therapeutic outcomes. This article reviews the progress of ICIs in ovarian cancer, including monotherapy and combination treatment strategies, and explores emerging therapeutic targets and strategies aimed at improving patient prognosis and achieving personalized treatment. By gaining a deeper understanding of the tumor microenvironment and its immune evasion mechanisms, there is hope for developing more effective treatment options in the future, ultimately improving the survival rates and quality of life for ovarian cancer patients.

Multi-Society Guideline on Cytoreductive Surgery and HIPEC: Methodology and Overview of the Results.

To provide evidence-based guidelines about Peritoneal Surface Malignancy (PSM) treatment for the Peritoneal Surfaces Oncology Group International. The GRADE ADOLOPMENT method was used to adapt recommendations from the Italian Medical Oncology Association Guideline on PSM. Seven scientific society were involved to form five guideline panels composed of 28 medical professionals from 14 countries. Panelists prioritized 7 relevant questions. A knowledge synthesis team updated evidence and summarized information. The panel agreed on seven recommendations.

ASO Visual Abstract: Management of the Uninvolved Uterus and Adnexa During Routine Pelvic Peritonectomy in Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Varies by Histology and Menopausal Status-An International Survey of Peritoneal Surface Malignancy Surgeons.

ASO Visual Abstract: Management of the Uninvolved Uterus and Adnexa During Routine Pelvic Peritonectomy in Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Varies by Histology and Menopausal Status-An International Survey of Peritoneal Surface Malignancy Surgeons.

Thermal Ablation and Intralesional Cisplatin Injection as Adjunct to Systemic Chemotherapy in Managing Malignant Central Airway Obstruction: A Case Report

Endobronchialultrasound (EBUS)-guidedintralesional chemotherapy and thermal ablation using cryotherapy and electrocautery can be used for the management of malignant central airway obstruction (CAO). This is a case of a 62-year-old male presenting with cough, hoarseness, and shortness of breath. He was diagnosed with squamous cell carcinoma stage IVA (T4N2M1a), causing malignant CAO that progressed to impending respiratory failure (ECOG PS 4). Chest CT scan findings included a left main bronchus mass measuring 3.7 x 5.8 x 5.9 cm causing complete atelectasis, a right pleural-based mass, and osteolytic destruction of the 3rd lateral ribs. Bronchoscopy showed a fungating, friable mass in the carina extending to the orifice of the right and left mainstem bronchus with 70% and 100% occlusion, respectively. A multimodality treatment approach was taken with tumor debulking by thermal ablation with cryotherapy and electrocautery, EBUS-guided intralesional cisplatin, and systemic chemotherapy. Subsequently, there was an interval decrease in the size of the tumor in multiple areas, with left lung re-expansion. The clinical symptoms of the patient significantly improved and ECOG status increased to 1. No adverse effects were noted post procedure. Intralesional cisplatin can be an effective and safe adjunct treatment in malignant CAO, alongside thermal ablation and systemic chemotherapy.

ASO Visual Abstract: Repeat Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) Using Open and Closed Abdomen Techniques for Colorectal Peritoneal Metastases and Peritoneal Pseudomyxoma Recurrences: Results from Six French Expert Centers.

ASO Visual Abstract: Repeat Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) Using Open and Closed Abdomen Techniques for Colorectal Peritoneal Metastases and Peritoneal Pseudomyxoma Recurrences: Results from Six French Expert Centers.

Effectiveness of hyperthermic intraperitoneal chemotherapy during primary curative resection for colorectal carcinoma

PurposePeritoneal metastasis (PM) is the life-threatening cause of colorectal cancer patients (CRC). Adjuvant hyperthermic intraperitoneal chemotherapy (HIPEC) plus cytoreductive surgery exhibited promising effects in preventing recurrence and increasing the survival of CRC patients. However, the outcomes of HIPEC on treating advanced CRC with risk of PM are still controversial. Here, we retrospectively examined the impact of HIPEC on preventing PM and its overall effects on patients with locally advanced CRC who underwent primary curative resection at our center.MethodsWe retrospectively analyzed 45 patients diagnosed with locally advanced colorectal cancer (CRC) who underwent primary curative laparoscopic surgery with proactive hyperthermic intraperitoneal chemotherapy (HIPEC), in conjunction with adjuvant systemic chemotherapy at our center between 2019 and 2022. An additional 55 patients with locally advanced CRC who underwent similar surgery and received adjuvant systemic chemotherapy but did not undergo HIPEC during the same period were selected as the control group. Disease-free survival (DFS), overall survival (OS), and PM incidence were compared between patients with and without HIPEC.Results and conclusionsThe cumulative PM incidence was 2.2% in the HIPEC group and 14.5% in the control group(P = 0.0347). No significant adverse effects were observed in the HIPEC group. Furthermore, Kaplan–Meier survival analysis showed that the HIPEC correlated to better DFS [hazard ratio (HR) 0.4670, 95% confidence interval (CI) 0.2305–0.9462; P = 0.0345] and extended the overall survival of CRC patients [hazard ratio (HR) 0.3978, 95% confidence interval (CI) 0.1684–0.9395; P = 0.0355]. Therefore, our data supports that adjuvant HIPEC can prevent peritoneal failure in CRC patients and improve both PFS and OS survival following primary curative resection.

Review of Imaging Peritoneal Disease and Treatment.

Peritoneal disease can be classified as either benign or malignant in nature. Malignant peritoneal disease can be further considered as either primary or secondary in origin. Primary peritoneal malignancy includes peritoneal mesothelioma, serous carcinoma, and desmoplastic small round cell tumour. Peritoneal carcinomatosis is the most commonly encountered secondary malignant peritoneal disease, typically of ovarian, gastric, colorectal, pancreatic, small bowel neuroendocrine, or breast origin. Others include peritoneal lymphomatosis and sarcomatosis. Benign peritoneal pathology may mimic malignant disease. Differentiating benign from malignant peritoneal pathology can be challenging, but is critical to guide appropriate care and avoid unnecessary intervention. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) offers potentially curative treatment for patients with peritoneal carcinomatosis, pseudomyxoma peritonei, and peritoneal mesothelioma. For such patients, the radiologist provides crucial pre-operative information highlighting sites of disease involvement, particularly for sites which are challenging to assess at laparotomy or laparoscopy, including the hepatic dome, subdiaphragmatic space and mesenteric root. The radiologist is also essential to identify potential contraindications to surgery, as well as interpreting normal post-operative appearances, complications and assessing for disease recurrence.

Value of miR200b and its combination with other biochemical markers in the diagnosis of epithelial ovarian cancer.

This study aimed to analyse the diagnostic performance of miR200b in epithelial ovarian cancer (EOC) in a group of Egyptian patients and to evaluate the combined use of miR200b with other biomarkers as a reliable diagnostic and prognostic indicator of EOC. We tested the expression of cell-free miR200b in 30 EOC patients before undergoing optimum cytoreductive surgery, 19 females with benign ovarian disease and 14 normal healthy females using quantitative real time PCR. All cases were tested for CA125, HE4 and CRP. The results were compared between the three groups. The double combination of miR200b with each biomarker was tested for a possible improvement of the diagnostic power of the test. MiR200b was significantly overexpressed in EOC patients compared to the other groups, we determined 1.88 folds as the best cutoff for miR200b expression to discriminate between EOC and non-malignant cases with a sensitivity of 63.3% and a specificity of 71%. CA125, HE4 and CRP were evaluated and showed a sensitivity of 96.7%, 45.5%, 81.8% respectively and a specificity of 75.9%, 66.7% and 90% respectively. We evaluated the combined use of miR200b with each biomarker, the best results were seen with the combined use of miR200b and CA125. We concluded that the combined use of miR200b and CA125 could serve as a reliable tool in the initial diagnosis of EOC, and a predictor of event free survival of the disease.

Undifferentiated uterine sarcoma : experience of a single center

ObjectivesTo investigate the clinicopathological characteristics and prognosis of patients with undifferentiated uterine sarcomas (UUS).Methods29 patients with UUS who were treated at our institution between 2001 and 2020 were analyzed.ResultsThe median age at diagnosis was 52 years (range: 26–70 years). The FIGO 2009 distribution by stage was as follows: stage I, 17 patients (58.6%); stage II, 5 patients (17.2%); stage III, 4 patients (13.8%); and stage IV, 3 patients (10.3%). For 28 patients who underwent surgical treatment, 27 patients (96.4%) underwent total/sub-radical/radical hysterectomy combined bilateral salpingo-oophorectomy, 17 (58.6%) pelvic lymphadenectomy, 7 (24.1%) para-aortic lymphadenectomy and 8 (28.6%) patients underwent omentectomy, as part of the initial surgical treatment. The median follow-up was 23.4 months (range: 4.5–200.2 months). 18 patients (62.1%) died during follow up, and 13 patients (72.2%, 13/18) died within 2 years after diagnosis. Median progression-free survival (mPFS) and overall survival (mOS) for the entire cohort were 15.5 and 27.4 months, respectively. 2-year and 5-year PFS were 40.3% and 26.9%. 2-year and 5-year OS were 54.0% and 36.5%. Stage-specific median PFS and OS were as follows: stage I-II—17.7 and 35.5 months, stage III-IV—6.0 and 6.7 months. Patients with recurrent UUS who underwent cytoreduction surgery associated with an improved overall survival (mOS: 52.9 vs. 17.9 months), but the difference was not statistically significant (P = 0.081).ConclusionsUUS are a rare group of tumors with an aggressive behavior and poor outcomes. A majority rapidly develops distant metastases despite surgical resection.

Analysis of long-term outcomes after surgical treatment of patients with complicated forms of colon cancer

The aim of the study. To evaluate long-term outcomes in patients who underwent surgery due to complications of colon cancer in a general surgical hospital. Materials and methods. The study group included 71 (100 %) patients with complicated forms of colon cancer. Radical surgical interventions were performed in 48 (67.6 %) patients, palliative cytoreductive operations – in 18 (25.4 %) hospitalized patients, symptomatic – in 5 (7.0 %) patients. Results. In the postoperative period, only 37 (58.7 %) patients sought help from an oncologist at the third level of medical care. The remaining 26 (41.3 %) patients refused to consult an oncologist and specific treatments for whatever reason. Conclusions. Of the 37 (58.7 %) operated patients who sought oncological care, a chemotherapy course was initiated for 19 (51.4 %), dynamic follow-up without specific treatments was recommended for 7 (18.9 %) patients and symptomatic treatments according to the standards of palliative medical care – for 9 (24.3 %). During the follow-up period, among 43 (68.3 %) patients with non-metastatic cancer, 6 (14.0 %) of the operated patients had local recurrences, 8 (18.6 %) – regional, and 12 (27.9 %) – distant ones. In 17 (39.5 %) patients, no findings on recurrent colon cancer were revealed. Cumulative 1-year and 3-year survival rates in this category of patients were 56.3 ± 5.9 % and 38.0 ± 5.8 %, respectively.

INDEPSO-ISPSM Consensus on Peritoneal Malignancies: Management of Colorectal Peritoneal Metastases.

This manuscript reports the results of the Indian Network for Development of Peritoneal Surface Oncology and Indian Society of Peritoneal Surface Malignancies (INDEPSO-ISPSM) consensus that aimed to provide recommendations for some important aspects management of patients with colorectal peritoneal metastases (CPM) and address some issues unique to India. The modified Delphi technique was used with two rounds of voting. There were 29 questions on nine main topics-the role of cytoreductive surgery (CRS), patient selection for CRS, preoperative workup, role of systemic chemotherapy (SC), CPM with other visceral metastases, molecular profile, hyperthermic intraperitoneal chemotherapy (HIPEC) and other modalities of intraperitoneal chemotherapy (IPC), prophylactic/preventive strategies, and surveillances after CRS. A consensus was achieved if anyone option received >70 votes (strong consensus >90%). Forty-eight surgical (n = 41) and gastrointestinal (n = 7) oncologists were invited; 44 agreed to participate. The response rate was 95.4% (42/44) in round 1 and 93.1% (41/44) in round 2. Overall, a consensus was achieved on 23/29 (79.3%) questions (strong consensus on 6/29 [20.6%]). The panel strongly recommended considering surgery for limited CPM with limited liver metastases (92.5%), not altering the surgical approach in patients with KRAS mutations (91.67%), and limiting the use of IPC for unresectable CPM outside clinical trials (95%). Adjuvant SC was recommended for all patients undergoing CRS (89.47%). CRS is a therapeutic option for selected patients with CPM including those with metachronous CPM (79.49) and signet ring cell cancers (76.92%). HIPEC was recommended outside clinical trials only for patients with peritoneal cancer index 11-15(80%). The panel recommended CRS for most indications but was very selective in recommending HIPEC and IPC outside clinical trials. These recommendations should be a useful resource in clinical decision making for clinicians treating CPM in India and regions with a similar sociodemographic background.

Hyperthermic intraperitoneal chemotherapy for recurrent ovarian cancer (CHIPOR): a randomised, open-label, phase 3 trial

Hyperthermic intraperitoneal chemotherapy (HIPEC) at interval cytoreductive surgery for ovarian cancer improves overall survival but its role in recurrent disease is uncertain. We aimed to compare outcomes in patients treated with or without HIPEC during surgery for recurrent ovarian cancer. The multicentre, open-label, randomised, phase 3 CHIPOR trial was conducted at 31 sites in France, Belgium, Spain, and Canada, and enrolled patients with first relapse of epithelial ovarian cancer at least 6 months after completing platinum-based chemotherapy. Eligible patients were aged 18 years or older with WHO performance status of less than 2. After six cycles of platinum-based chemotherapy (and optional bevacizumab), patients amenable to complete cytoreductive surgery were randomly assigned centrally in a 1:1 ratio, using a web-based system and a minimisation procedure, during surgery to receive HIPEC (cisplatin 75 mg/m2 in 2 L/m2 of serum at 41±1°C for 60 min) or not, stratified by centre, completeness of cytoreduction score, platinum-free interval, and latterly, planned poly(ADP-ribose) polymerase inhibitor use. The primary endpoint was overall survival, analysed on an intention-to-treat basis in all randomly assigned patients. This ongoing trial is registered with ClinicalTrials.gov, NCT01376752. Between May 11, 2011, and May 14, 2021, 415 female patients were randomly assigned (207 HIPEC, 208 no HIPEC). At the primary analysis (median follow-up 6·2 years, IQR 4·1-8·1), 268 (65%) patients had died (126 [61%] of 207 in the HIPEC group; 142 [68%] of 208 in the no-HIPEC group). Overall survival was significantly improved with HIPEC (stratified hazard ratio 0·73, 95% CI 0·56-0·96; p=0·024). Median overall survival was 54·3 months (95% CI 41·9-61·7) with HIPEC versus 45·8 months (38·9-54·2) without. Grade 3 or worse adverse events within 60 days after surgery occurred in 102 (49%) of 207 patients receiving HIPEC versus 56 (27%) of 208 receiving no HIPEC, the most common being anaemia (47 [23%] vs 30 [14%]), hepatotoxicity (23 [11%] vs 18 [9%]), electrolyte disturbance (28 [14%] vs two [1%]), and renal failure (20 [10%] vs three [1%]). There were three deaths within 60 days of surgery, all in the no-HIPEC group. Adding HIPEC to cytoreductive surgery after response to platinum-based chemotherapy at first epithelial ovarian cancer recurrence significantly improved overall survival. When treating patients with late first relapse of high-grade serous or high-grade endometrioid ovarian cancer amenable to complete cytoreductive surgery at specialist centres, platinum-based HIPEC should be considered to extend overall survival. French National Cancer Institute and French League Against Cancer.

Outcome of patients with a peritoneal surface malignancy referred to a tertiary center specialized in cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Outcome of patients with a peritoneal surface malignancy referred to a tertiary center specialized in cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Perioperative predictors of major postoperative complications in cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy: a multivariate analysis of 168 procedures

Perioperative predictors of major postoperative complications in cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy: a multivariate analysis of 168 procedures

Current status of postoperative morbidity after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in colorectal cancer with peritoneal metastasis

Current status of postoperative morbidity after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in colorectal cancer with peritoneal metastasis

Cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy for synchronous liver and Peritoneal metastases from colorectal cancer: Where are we going?

Cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy for synchronous liver and Peritoneal metastases from colorectal cancer: Where are we going?

Cytoreductive surgery and intra-peritoneal chemotherapy for peritoneal metastasis of colorectal cancer: analysis of prognostic factors related to survival

Cytoreductive surgery and intra-peritoneal chemotherapy for peritoneal metastasis of colorectal cancer: analysis of prognostic factors related to survival

Risk Factors for Early Versus Late Venous Thromboembolism after Cytoreductive Surgery and HIPEC

Risk Factors for Early Versus Late Venous Thromboembolism after Cytoreductive Surgery and HIPEC

Survival outcomes of peritoneal surface malignancies treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: Preliminary results from a single-center study

Survival outcomes of peritoneal surface malignancies treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: Preliminary results from a single-center study

Textbook oncologic outcome is an easy-to-use composite quality measure that is strongly associated with survival in advanced-stage ovarian cancer

ObjectiveTextbook oncologic outcome (TOO) has been validated in surgical oncology as a composite quality measure correlated with oncologic outcomes. We aimed to assess the association between TOO and overall survival (OS) in patients undergoing primary treatment for advanced epithelial tubo-ovarian cancer (AEOC). MethodsPatients undergoing surgery for AEOC between 2008 and 2019 were identified in the National Cancer Database (NCDB). Primary debulking surgery (PDS) and interval debulking surgery (IDS) cohorts were analyzed separately. TOO was defined as achieving complete debulking, length of hospital stay <10 days, no 30-day readmission, no death within 90 days, and initiation of adjuvant chemotherapy within 42 days. The Kaplan-Meier method was used to estimate 5-year OS by TOO status and Cox regression to evaluate the relationship between TOO and death within 5 years. ResultsA total of 21,657 patients were included: 51.4% in the PDS cohort and 48.6% in the IDS cohort. TOO was achieved (TOO+) in 20.5% of the PDS cohort and 39.2% of the IDS cohort. For the PDS cohort, achieving TOO was associated with improved 5-year OS: 59.0% TOO+ vs. 39.5% TOO- (HR 0.53, 95% CI 0.49–0.57). For the IDS cohort, a similar benefit was seen for 5-year OS: 43.9% TOO+ vs. 31.2% TOO- (HR 0.67, 95% CI 0.63–0.70). Multivariable analysis demonstrated that patients achieving TOO were at lower risk of death within 5 years in both the PDS cohort (HR 0.58, 95% CI 0.54–0.62) and the IDS cohort (HR 0.69, 95% CI 0.65–0.73). ConclusionsThe TOO composite measure is associated with improved long-term survival and could be a useful quality assessment tool for patients undergoing primary treatment for AEOC, irrespective of surgical timing. This tool reflects the ability to deliver risk-based individualized decision-making using a multidisciplinary approach.