Isolated Peritoneal Metastases Research Articles

Solitary Peritoneal Metastasis in Case of Osteosarcoma Detected by FDG PET/CT.

Primary osteosarcomas predominantly originate in the metaphyseal region of long bones. The introduction of 18F-FDG PET/CT imaging has revealed unusual and often rare sites of metastatic spread. Peritoneal deposits in osteosarcoma are not a commonly reported finding in the literature. The present case highlights the 18F-FDG PET/CT findings in a case of osteosarcoma of the left fibula with isolated peritoneal metastasis with no regional or distant metastases.

Role of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in the Management of Colorectal Peritoneal Metastases.

Peritoneal metastases from colon cancer are a particularly challenging disease process given the limited response to systemic chemotherapy. In patients with isolated peritoneal metastases, cytoreductive surgery with hyperthermic intraperitoneal chemotherapy offers a potential treatment option to these patients with limited peritoneal metastases as long as a complete cytoreduction is achieved. Decision about a patient's candidacy for this treatment modality should be undertaken by a multidisciplinary group at expert centers.

P-OGC55 Current treatment modalities and median survival for patients with gastric and oesophagogastric cancers with isolated peritoneal metastasis

Abstract Background Gastric cancer with peritoneal metastases carries a median survival of only 3-7 months without treatment. Meanwhile, cancers arising from the oesophago-gastric junction (OGJ) are rapidly increasing in incidence in the Western population and are also commonly associated with peritoneal metastases. In order to measure the efficacy of emerging modes of treatment for peritoneal disease, it is essential to describe the treatments patients currently receive and the impact of these on survival – data for which is poorly described in the literature and lacking in the UK setting. Methods This was a single hospital-based retrospective cohort study covering the period from March 2012 to January 2020 at a tertiary referral centre. 50 patients were identified from multidisciplinary team (MDT) meeting records receiving a diagnosis of gastric adenocarcinoma with isolated peritoneal disease. 31 patients were identified receiving a diagnosis of true (Siewert II or III) junctional adenocarcinoma with isolated peritoneal disease. We calculated median survival time for all patients and also by treatment modality. Results Mean age of patients with gastric adenocarcinoma and isolated peritoneal disease was 71 years (range 44-90). Overall median survival was 6.6 months (IQR 2.4-19.3). Median survival was 11.2 months (IQR 3.7-21.5) for patients receiving systemic chemotherapy (n = 26) and 2.4 months (IQR 1.2-5.1) for patients receiving best supportive care alone (n = 15). Mean age of patients with junctional adenocarcinomas and isolated peritoneal disease was 70 years (range 37-89). Overall median survival was 7 months (IQR 3-19). Median survival was 10.5 months (IQR 6.5-20.5) for patients receiving systemic chemotherapy (n = 20) and 3.5 months (IQR 2-6) for patients receiving best supportive care alone (n = 6). Conclusions Our results demonstrate the poor prognosis of both gastric and oesophagogastric cancer patients with isolated peritoneal disease. Prognosis figures are comparable between the two cancer types. Findings are in line with previous studies performed outside the UK which have shown that available treatments extend survival by no more than 3-9 months, highlighting the desperate need for new treatment modalities.

Risk Factors for Metachronous Isolated Peritoneal Metastasis after Preoperative Chemotherapy and Potentially Curative Gastric Cancer Resection: Results from the CRITICS Trial.

Simple SummaryAround 20% of gastric cancer patients develop peritoneal metastasis after preoperative chemotherapy and curative surgery. Patients with peritoneal metastasis as a single site of metastasis may potentially benefit from prophylactic strategies. In this post-hoc analysis of the international phase III CRITICS trial, we aim to identify factors that can distinguish patients at high risk for developing peritoneal metastasis as a single site. Diffuse or mixed histological subtype, tumors with serosal involvement (ypT4) and advanced lymph node stage (ypN3 or a tumor positive lymph node ratio >20%) were independent risk factors for isolated peritoneal metastasis after preoperative chemotherapy and curative surgery. The combination of these risk factors identifies a subgroup that may benefit from treatment strategies that aim to prevent peritoneal metastasis.Gastric cancer (GC) patients at high risk of developing peritoneal metastasis (PM) as a single site of metastasis after curative treatment may be candidates for adjuvant prophylactic strategies. Here we investigated risk factors for metachronous isolated PM in patients who were treated in the CRITICS trial (NCT00407186). Univariable and multivariable analyses on both metachronous isolated PM and ‘other events’, i.e., (concurrent) distant metastasis, locoregional recurrence or death, were performed using a competing risk model and summarized by cumulative incidences. Isolated PM occurred in 64 of the 606 (11%) included patients. Diffuse or mixed histological subtype, ypT4 tumor stage and LNhigh (ypN3 lymph node stage or a lymph node ratio >20%) were independent risk factors for isolated PM in both univariable and multivariable analyses. Likewise, LNhigh was an independent risk factor for ‘other events’. Patients with tumors who were positive for all three independent risk factors had the highest two-year cumulative incidence of 43% for isolated PM development. In conclusion, diffuse or mixed histological subtype, ypT4 and LNhigh were identified as independent risk factors for isolated PM in patients treated with preoperative chemotherapy followed by surgical resection. The combination of these factors may identify a subgroup that may benefit from PM-preventing treatment strategies.

Diagnostic and therapeutic algorithm for colorectal peritoneal metastases. A consensus of the peritoneal surface malignancies onco-team of the Italian society of surgical oncology

Aimthe surgical workup for colorectal cancer peritoneal metastases (CRCPM) is complex and should be managed in specialized centers. Diagnostic and therapeutic algorithms (DTA) have been proposed to balance optimal patients management and correct use of resources. Aim of this study was to establish a consensus on DTA for CRCPM patients in Italy. Methoda panel of 18 delegated members of centers afferent to Peritoneal Surface Malignancies Onco-team of the Italian Society of Surgical Oncology was established. A list of statements regarding the DTA of patients with CRCPM was prepared according to different activities and decision-making nodes with a defined entry and exit point. Consensus was obtained through RAND UCLA methodology. Resultstwo different DTA were defined and approved according to the modality of presentation of CRCPM (synchronous and metachronous). A consensus was also obtained on 17 of the 19 statements related to DTA. Conclusiona shared model of DTA is now available for healthcare providers to monitor appropriateness in diagnosis and treatment of patients with isolated peritoneal metastases from CRC.

Abstract 708: Limited release of circulating tumor DNA into the systemic circulation by peritoneal metastases from colorectal cancer

Abstract Introduction: Circulating tumor DNA (ctDNA) from plasma is a promising biomarker. Patients with metastatic colorectal cancer (CRC) often have high ctDNA levels compared to other cancer types. However, it is unclear whether this is also the case for patients with peritoneal metastases from CRC. Aim: To compare the propensity of ctDNA shedding by isolated liver metastases and isolated peritoneal metastases from CRC. Methods: Plasma was collected from 100 CRC patients (64% male, mean age of 60 [SD=10] years) with isolated unresectable liver metastasis (CRC-LM). Plasma and ascites were obtained from 20 CRC patients (60% male, mean age of 63 [SD=9.8] years) with isolated unresectable peritoneal metastases (CRC-PM). All liquid biopsies were obtained prior to treatment and cell-free DNA was isolated using the QIAsymphony (Qiagen, Germany) and assessed by droplet digital PCR (ddPCR; Bio-Rad, Hercules, USA). Patients with a KRAS or BRAF tumor tissue mutation were suited for plasma ctDNA ddPCR analysis, and were detected in 57 CRC-LM (57%) and 11 CRC-PM (55%) patients. The ability to shed ctDNA into the circulation was evaluated by comparing KRAS/BRAF mutation status in plasma and ascites with the mutation status based on tumor tissue. Regarding liquid biopsies, mutant allele fraction (MAF) and mutant copies per ml input (MTc/ml) were reported. Results: Tissue mutations could be confirmed in plasma in 93% of CRC-LM and only 20% of CRC-PM patients, whereas mutations were detected in ascites in 100% of CRC-PM patients. The MAF and MTc/ml were both significantly lower in CRC-PM plasma ctDNA (median MAF=0.28% and MTc/ml=21) compared to CRC-LM plasma ctDNA (median MAF=18.9% and MTc/ml= 1758; P<0.0001). In addition, the MAF and MTc/ml were significantly higher in CRC-PM ascites ctDNA (median MAF=16.4%, MTc/ml=305) compared to plasma ctDNA (median MAF=0.28%, MTc/ml=21; P<0.0001). Conclusion: To our knowledge, this is the first study showing a comprehensive comparison of tissue, blood and ascites derived genomic information in patients with CRC and extensive isolated peritoneal metastases. This study concludes that isolated peritoneal metastases from CRC is a malignancy with distinct clinical and biological characteristics, which should be taken into account when considering the clinical utility of ctDNA in different metastatic setting of CRC. To detect genomic alterations, the blood circulation is the preferred source of ctDNA in case of CRC liver metastases, whereas ascites offers an alternative to plasma in patients with peritoneal metastases, which might be suitable as diagnostic, prognostic, predictive or disease monitoring biomarker. Citation Format: Iris van 't Erve, Koen P. Rovers, Alexander Constantinides, Karen Bolhuis, Emma C. Wassenaar, Robin J. Lurvink, Clément J. Huysentruyt, Petur Snaebjornsson, Daan van den Broek, Tineke E. Buffart, Niels F. Kok, Gerrit A. Meijer, Cornelis J. Punt, Onno Kranenburg, Ignace H. de Hingh, Remond J. Fijneman. Limited release of circulating tumor DNA into the systemic circulation by peritoneal metastases from colorectal cancer [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 708.

A real-world, population-based study of the outcomes of patients with metastatic colorectal cancer to the peritoneum treated with or without cytoreductive surgery.

To assess the outcomes of metastatic colorectal cancer patients with isolated peritoneal metastasis who were treated with or without cytoreductive surgery in a contemporary real-world, population-based cohort. Surveillance, Epidemiology, and End Results (SEER) database has been accessed and metastatic colorectal cancer patients to the peritoneum who have no evidence of other sites of distant metastases and who were diagnosed 2010-2015 were reviewed. Multivariable logistic regression analysis was then used to assess the patient- and treatment-related factors predicting the decision to do cytoreductive surgery. Kaplan-Meier survival estimates were used to compare overall survival according to cytoreductive surgery. Multivariable Cox regression analysis was additionally used to assess the impact of cytoreductive surgery on colorectal cancer-specific survival. A total of 3153 records were reviewed in the current analysis. Using Kaplan-Meier survival estimates, cytoreductive surgery was associated with improved overall survival (median overall survival, 19months for patients with cytoreductive surgery versus 12months for patients without cytoreductive surgery; P < 0.001). In an adjusted Cox regression model evaluating the impact of cytoreductive surgery on colorectal cancer-specific survival, cytoreductive surgery was associated with better colorectal cancer-specific survival (hazard ratio for death among patients who did not have cytoreductive surgery versus patients who had cytoreductive surgery, 1.312; 95% CI, 1.175-1.465; P < 0.001). Cytoreductive surgery is associated with improved survival outcomes among colorectal cancer patients with peritoneal metastasis and no evidence of other distant metastases. Opimal utilization of this intervention needs to be further evaluated in prospective controlled trials.

Surgical treatment of intraperitoneal metastases from lung cancer: two case reports\xa0and a\xa0review of the literature

BackgroundPeritoneal metastases are often reported in several abdominal tumors. Peritoneal diffusion from extra-abdominal tumors is thought to be rare. Lung cancer is one of the most common cancers in the world with early metastases and it is associated with poor prognosis in advanced stages. Peritoneal metastases from lung cancer are uncommon and the real mechanism of its diffusion to the peritoneum is unknown. However, its clinical behavior is similar to any other peritoneal metastasis from abdominal tumors.Case presentationWe present two Caucasian patients (a 44-year-old man and a 59-year-old man) with bowel obstruction from peritoneal metastases from non-small cell lung cancer who successfully underwent emergency cytoreductive surgery and had a good prognosis and survival.ConclusionsIn our patients with isolated peritoneal metastases from lung cancer, cytoreduction showed good prognosis with acceptable morbidity. This treatment option might be considered in highly selected cases to improve survival. Strict follow-up is mandatory to allow early diagnosis of peritoneal diffusion.

Benefit of cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy in patients with isolated peritoneal metastases from colorectal cancer.

Ever since Sugarbaker has established the cytoreductive surgery (CRS) in combination with intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC), there is a chance of cure for selected patients with peritoneal metastases from colorectal cancer. Objective of this study was to investigate the benefit of CRS and HIPEC compared to other therapy options in patients with isolated synchronous and metachronous peritoneal metastases of colorectal origin in terms of long-term overall survival. A retrospective population-based cohort study, including 370 patients diagnosed with isolated synchronous and metachronous peritoneal metastases of colorectal origin, was carried out. Therefore, data were acquired from the cancer registry at the Regensburg Tumor Center in Bavaria, Germany. Patients' overall survival (OAS) according to their therapy received was analyzed by means of Kaplan-Meier method and multivariable Cox regression. Overall median survival was 41.6months for patients treated with CRS and HIPEC, compared with surgery and chemotherapy (24.0months, log-rank p = 0.015), chemotherapy only (14.1months, p < 0.001), surgery only (11.4months, p < 0.001), and best supportive care (7.9months, p < 0.001). This benefit persisted after adjustment for further risk factors in multivariable analysis. The effect of CRS and HIPEC stands out significantly in comparison to all other therapies. The multimodality approach should be a regular option for patients with isolated peritoneal metastases.

Prognosis of patients with peritoneal metastatic colorectal cancer given systemic therapy: an analysis of individual patient data from prospective randomised trials from the Analysis and Research in Cancers of the Digestive System (ARCAD) database

Patients with peritoneal metastatic colorectal cancer have reduced overall survival compared with patients with metastatic colorectal cancer without peritoneal involvement. Here we further investigated the effect of the number and location of metastases in patients receiving first-line systemic chemotherapy. We analysed individual patient data for previously untreated patients enrolled in 14 phase 3 randomised trials done between 1997 and 2008. Trials were included if protocols explicitly pre-specified and solicited for patients with peritoneal involvement in the trial data collection process or had done a formal peritoneum-focused review of individual pre-treatment scans. We used stratified multivariable Cox models to assess the prognostic associations of peritoneal metastatic colorectal cancer with overall survival and progression-free survival, adjusting for other key clinical-pathological factors (age, sex, Eastern Cooperative Oncology Group (ECOG) performance score, primary tumour location [colon vs rectum], previous treatment, and baseline BMI). The primary endpoint was difference in overall survival between populations with and without peritoneal metastases. Individual patient data were available for 10 553 patients. 9178 (87%) of 10 553 patients had non-peritoneal metastatic colorectal cancer (4385 with one site of metastasis, 4793 with two or more sites of metastasis), 194 (2%) patients had isolated peritoneal metastatic colorectal cancer, and 1181 (11%) had peritoneal metastatic colorectal cancer and other organ involvement. These groups were similar in age, ethnic origin, and use of targeted treatment. Patients with peritoneal metastatic colorectal cancer were more likely than those with non-peritoneal metastatic colorectal cancer to be women (565 [41%] of 1371 vs 3312 [36%] of 9169 patients; p=0·0003), have colon primary tumours (1116 [84%] of 1334 patients vs 5603 [66%]; p<0·0001), and have performance status of 2 (136 [10%] vs 521 [6%]; p<0·0001). We recorded a higher proportion of patients with mutated BRAF in patients with peritoneal-only (eight [18%] of 44 patients with available data) and peritoneal metastatic colorectal cancer with other sites of metastasis (34 [12%] of 289), compared with patients with non-peritoneal metastatic colorectal cancer (194 [9%] of 2230; p=0·028 comparing the three groups). Overall survival (adjusted HR 0·75, 95% CI 0·63-0·91; p=0·003) was better in patients with isolated non-peritoneal sites than in those with isolated peritoneal metastatic colorectal cancer. Overall survival of patients with two of more non-peritoneal sites of metastasis (adjusted HR 1·04, 95% CI 0·86-1·25, p=0.69) and those with peritoneal metastatic colorectal cancer plus one other site of metastasis (adjusted HR 1·10, 95% CI 0·89-1·37, p=0·37) was similar to those with isolated peritoneal metastases. Compared with patients with isolated peritoneal metastases, those with peritoneal metastases and two or more additional sites of metastasis had the shortest survival (adjusted HR 1·40; CI 1·14-1·71; p=0·0011). Patients with peritoneal metastatic colorectal cancer have significantly shorter overall survival than those with other isolated sites of metastases. In patients with several sites of metastasis, poor survival is a function of both increased number of metastatic sites and peritoneal involvement. The pattern of metastasis and in particular, peritoneal involvement, results in prognostic heterogeneity of metastatic colorectal cancer. None.

Peritoneal debulking/intraperitoneal chemotherapy—non‐sarcoma

The combination of cytoreductive surgery (CRS) and intraperitoneal chemotherapy (IPC) is widely practiced for appendiceal, colorectal, gastric, and ovarian cancers with isolated peritoneal metastasis as well as for primary peritoneal cancer. The aim of this report is to explain the rationale and available techniques for CRS and IPC, and to highlight disease-specific considerations that should be taken into account when evaluating potential candidates for CRS and IPC.

Early Postoperative Intraperitoneal Chemotherapy Following Cytoreductive Surgery for Appendiceal Mucinous Neoplasms With Isolated Peritoneal Metastasis

Although cytoreductive surgery and intraperitoneal chemotherapy have been advocated as standard treatment for appendiceal neoplasms with isolated peritoneal metastasis, the optimal method of chemotherapy administration has not been established. At our institution, patients undergoing complete cytoreduction in this setting typically receive multiple cycles of early postoperative intraperitoneal chemotherapy. The aim of this study was to describe patients with appendiceal neoplasms and peritoneal dissemination treated with complete cytoreductive surgery and early postoperative intraperitoneal chemotherapy and to document associated time to progression and morbidity. This is a retrospective study at a single specialty institution. Hospital and departmental databases were searched for patients presenting with primary appendiceal neoplasms undergoing cytoreductive surgery, placement of intraperitoneal port, and subsequent intraperitoneal chemotherapy from June 1995 to September 2009. This study was conducted at Memorial Sloan-Kettering Cancer Center. We identified 50 patients (30 female), median age 48 (range, 26-66) who met the criteria. Cytoreductive surgery, placement intraperitoneal port, and intraperitoneal chemotherapy were performed. All patients underwent intraperitoneal catheter placement after complete cytoreductive surgery, followed by a median of 4 cycles (range, 1-9) intraperitoneal 5-fluoro-2'-deoxyuridine (1000 mg/m daily for 3 days) plus leucovorin (240 mg/m). The median hospital length of stay was 9 days (maximum, 29). Thirty-four percent of the patients experienced complications; 12% experienced major complications (3 abdominal abscesses, 1 deep vein thrombosis, 1 abdominal hemorrhage, and 1 intraperitoneal port malfunction). There were no 30-day mortalities. Five-year recurrence-free interval was observed in 43%. Among 23 patients with recurrence, 18 had a recurrence only within the peritoneum. The median overall survival was 9.8 years. This is a retrospective study. Many patients had surgery first at other institutions; therefore, pathologic examination of resected material was not possible in every case. Other factors possibly impacting time to recurrence (ie, preoperative chemotherapy, duration between onset of disease and presentation to our institution) varied among patients and were not controlled for. In the absence of a control arm undergoing complete cytoreduction without early postoperative intraperitoneal chemotherapy, we did not ascertain whether intraperitoneal chemotherapy confers additional benefit. Cytoreductive surgery plus multiple cycles of early postoperative intraperitoneal chemotherapy is safe, achieving survival results similar to published outcomes of other protocols (including hyperthermic intraperitoneal chemotherapy). Prospective trials are warranted to compare various methods of intraperitoneal chemotherapy in this setting.

Embryonal Sarcoma of the Liver in an Adult Patient

Undifferentiated embryonal sarcomas (UESs) are uncommon tumours that are seen predominantly in late childhood. Cases in adults are rare and generally present once a large mass develops and may be mistaken for other tumours. A case of an UES of the liver with an isolated peritoneal metastasis is described. The patient presented with a palpable mass with imaging findings suggestive of a cystic tumour. She had complete surgical resection of the liver mass and isolated peritoneal metastasis. She was tumour-free on imaging at 6 months without adjuvant chemotherapy. An UES should be considered in the differential of large cystic hepatic lesions, with aggressive surgical resection considered when possible.

Relapse with isolated peritoneal metastasis in lung adenocarcinoma: and review of the literature

Lung cancer rarely involves the peritoneum without involvement of other metastatic sites. The most common regions of metastasis are the pleura, lung parenchyma, skeletal system, liver, brain, and adrenal glands. Compared with pleural metastasis, peritoneal involvement is rarely encountered in lung carcinoma. Ascites development is often described during late stages of the disease, following diagnosis in patients with serosal involvement other than pleural metastases. Diagnosis is based on histopathological or cytological examination confirmed by the presence of malign cells in the peritoneal fluids. Metastatic involvement of other areas is common and expected in cancer patients in whom peritoneal metastasis develop. There are no pulished reports of lung cancer cases with involvement of only the peritoneum without metastases to other more common regions. Herein we present a rare case of non-small cell lung carcinoma involving the peritoneum. The presented case had an unusual course and relapsed with peritoneal carcinomatosis without involvement of other regions.

A case of isolated peritoneal metastasis in clinically early stage squamous cell carcinoma of the uterine cervix

A case of isolated peritoneal metastasis in clinically early stage squamous cell carcinoma of the uterine cervix

Gene expression differentiates liver metastases from isolated peritoneal metastases in colorectal cancer

15022 Background: Metastatic spread is the leading cause of colorectal cancer deaths. In a minority of patients, peritoneal carcinomatosis (PC) develops in the absence of distant metastasis. It is ...