scholarly journals Canadian guidelines on the management of colorectal peritoneal metastases

2020 ◽  
Vol 27 (6) ◽  
Author(s):  
A. Brind'Amour ◽  
P. Dubé ◽  
J.F. Tremblay ◽  
M.L. Soucisse ◽  
L. Mack ◽  
...  
Keyword(s):  
Poor Prognosis ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Systemic Chemotherapy ◽  
Peritoneal Metastases ◽  
Management Approach ◽  
Optimal Management ◽  
Good Patient ◽  
Surgical Oncologist ◽  
Disease Free

 Modern management of colorectal cancer (crc) with peritoneal metastasis (pm) is based on a combination of cytore­ductive surgery (crs), systemic chemotherapy, and hyperthermic intraperitoneal chemotherapy (hipec). Although the role of hipec has recently been questioned with respect to results from the prodige 7 trial, the role and benefit of a complete crs were confirmed, as observed with a 41-month gain in median survival in that study, and 15% of patients remaining disease-free at 5 years. Still, crc with pm is associated with a poor prognosis, and good patient selection is essential. Many questions about the optimal management approach for such patients remain, but all patients with pm from crc should be referred to, or discussed with, a pm surgical oncologist, because cure is possible. The objective of the present guideline is to offer a practical approach to the management of pm from crc and to reflect on the new practice standards set by recent publications on the topic.

scholarly journals Does additional HIPEC help after CRS in peritoneal disseminated gastric cancer?

2017 ◽  
Vol 30 (4) ◽  
pp. 187-189
Author(s):  
Beate Rau ◽  
Eva Pachmayr ◽  
Dusan Klos ◽  
Peter Thuss-Patience ◽  
Andreas Brandl
Keyword(s):  
Gastric Cancer ◽  
Poor Prognosis ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Systemic Chemotherapy ◽  
Recent Literature ◽  
Chemotherapeutic Agent ◽  
Therapeutic Option ◽  
Locally Advanced ◽  
Peritoneal Metastases ◽  
Locally Advanced Gastric Cancer

Abstract The incidence of synchronous or metachronous peritoneal metastases (PM) in patients with locally advanced gastric cancer is high, and associated with a poor prognosis. The recommended therapeutic option for these patients is systemic chemotherapy and leads to a median of 7-8 months. However, new approaches like cytoreductive surgery and hyperthermic intraperitoneal chemotherapy might help to improve the median survival in selected patients. Indications, patient selection and the choice of the chemotherapeutic agent are described in this manuscript, as well as an overview of the most recent literature about this topic.

Survival according to mutations in BRAF, KRAS, or microsatellite instability (MSI-H) after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with peritoneal metastases from colorectal cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 3565-3565 ◽  
Author(s):  
Stein G Larsen ◽  
Svein Dueland ◽  
M Goscinski ◽  
Sonja Steigen ◽  
Eva Hofsli ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Disease Free Survival ◽  
Peritoneal Metastases ◽  
Wild Type ◽  
Free Survival ◽  
Crs And Hipec ◽  
Disease Free

3565 Background: Patients with metastatic colorectal cancer (mCRC) and mutations in BRAF V600E (mutBRAF) or KRAS (mutKRAS) have a worse prognosis after liver or lung surgery/ablation, whereas the impact of microsatellite instability (MSI-H) has not been well studied. Few patients with mutBRAF receive liver or lung surgery (1-4%), whereas mutBRAF is present in 5-12% of mCRC trial patients and in up to 20% of the general mCRC population. The frequency and prognostic role of mutBRAF, mutKRAS and MSI has not been well studied after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal metastases from colorectal cancer. Methods: The Norwegian Radium Hospital is the only center offering CRS and HIPEC in Norway. From 2004 to 2015 257 patients with histology proven peritoneal metastasis from colorectal cancer, appendiceal cancer excluded, was consecutively enrolled. Molecular analyses of KRAS, BRAF and MSS/MSI in mutBRAF were done. Fourteen patients were excluded due to missing tumour blocks (7), unsuccessful analysis (4) and other malignant disease (1). Results: 180 of 243 patients obtained complete cytoreductive surgery and received HIPEC for 90 minutes with Mitomycin C (45-70mg). Median survival for the 180 patients was 47 months and 5-year survival rate 40.1%. Median disease-free survival was 10 months. mutBRAF was found in 23.4% of cases, mutKRAS 35.1% and double-wild type 41.5%. mutBRAF with MSS was found in 16.4%, mutBRAF with MSI-H in 7.0%. 3-year disease free survival (DFS) and median overall survival (OS) was 38.9% and 59 months with mutBRAF with MSI-H, significantly higher compared to 24.2% and 30 months in patients with double wild type, 13.2 % and 41 months in mutKRAS and 17.9% and 22 months in mutBRAF with MSS. Conclusions: A surprisingly high frequency of mutBRAF was seen in mCRC patients after CRS and HIPEC for peritoneal metastatic disease. Patients with mutBRAF and MSI-H had a significantly better DFS and OS after CRS and HIPEC. DFS for patients with mutBRAF and MSS was numerically lower but not statistically different from patients with mutKRAS or double wild type.

Gastric cancer liver metastasis: Optimal management for oligo-metastatic disease.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 136-136 ◽  
Author(s):  
Hiromichi Ito ◽  
Nobuyuki Takemura ◽  
Yoshihiro Ono ◽  
Takafumi Sato ◽  
Yoshihiro Mise ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Liver Resection ◽  
Liver Metastasis ◽  
Medical Records ◽  
Optimal Management ◽  
Curative Intent ◽  
Entire Cohort ◽  
Disease Free

136 Background: The role of surgery for gastric cancer liver metastasis (GCLM) has not been established and particularly, the optimal management for liver-isolated, oligo-GCLMs remains controversial. The aims of this study were to review the outcomes for our patients with GCLM who underwent liver resection and to define the optimal selection criteria for resection. Methods: The medical records of patients who underwent liver resection for GCLMs with curative intent at our institution from 1993 through 2018 were reviewed. Our criteria for liver resection included absence of extrahepatic disease, and the limited number of liver metastasis (often 3 or less). Results: Total 101 patients with GCLM (77 men [76%], median age 66 years) were included. Forty-seven patients (46%) had synchronous metastasis and all underwent simultaneous resection with the primary disease. Those with synchronous disease received neoadjuvant therapy more often than those with metachronous disease (63% vs 37%, p = 0.021). Median RFS and OS for the entire cohort were 11 months and 39 months, respectively, and 5-year-OS rate was 41%. Of note, 25 patients achieved survival longer than 5 years without any recurrence thereafter with median follow-up of 137 months. In the multivariate analyses, elevated CEA 50 ng/ml or greater and nodal status of the primary were associated with shorter RFS, while primary T4 disease, liver tumor 5cm or great and elevated CEA were associated with shorter OS (Table 1). Conclusions: For well selected patients with GCLM, liver resection is an effective therapy not only to prolong disease-free time, but also to achieve cure. CEA is useful to select patients with GCLM who unlikely benefit from aggressive surgery. [Table: see text]

scholarly journals Diagnosis and Management of Peritoneal Metastases from Ovarian Cancer

2012 ◽  
Vol 2012 ◽  
pp. 1-12 ◽  
Author(s):  
Evgenia Halkia ◽  
John Spiliotis ◽  
Paul Sugarbaker
Keyword(s):  
Ovarian Cancer ◽  
Epithelial Ovarian Cancer ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Peritoneal Metastasis ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Peritoneal Metastases ◽  
Diagnostic Tools ◽  
Advanced Epithelial Ovarian Cancer

The management and the outcome of peritoneal metastases or recurrence from epithelial ovarian cancer are presented. The biology and the diagnostic tools of EOC peritoneal metastasis with a comprehensive approach and the most recent literatures data are discussed. The definition and the role of surgery and chemotherapy are presented in order to focuse on the controversial points. Finally, the paper discusses the new data about the introduction of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment of advanced epithelial ovarian cancer.

scholarly journals High Pretreatment LDH Predicts Poor Prognosis in Hypopharyngeal Cancer

2021 ◽  
Vol 11 ◽  
Author(s):  
Jialing Wu ◽  
Kaiyun You ◽  
Changlong Chen ◽  
Huimin Zhong ◽  
Yanhui Jiang ◽  
...  
Keyword(s):  
Poor Prognosis ◽  
Multivariate Analyses ◽  
Univariate Analysis ◽  
Elevated Serum ◽  
Disease Free Survival ◽  
Hypopharyngeal Cancer ◽  
Prognostic Role ◽  
Free Survival ◽  
Disease Free

BackgroundElevated pretreatment lactate dehydrogenase (LDH) has been associated with poor prognosis in various malignancies; however, its prognostic role in hypopharyngeal cancer remains elusive. In this study, we aimed to assess the association between pretreatment LDH and clinical outcome of hypopharyngeal cancer.MethodsWe retrospectively collected 198 hypopharyngeal cancer patients treated with surgery in our institution between 2004 and 2018. The prognostic role of pretreatment LDH was explored by using univariate and multivariate analyses. Besides, subgroup analysis was performed based on T stage.ResultsThree-year and Five-year of disease-free survival (DFS, 67.0 vs. 57.4%, 65.8 vs. 39.8%, p = 0.007) and overall survival (OS, 74.8 vs. 68.9%, 66.8 vs. 50.8%, p = 0.006) exhibited significant differences between low LDH level and high LDH level groups. Univariate analysis showed that pretreatment elevated serum LDH served as an unfavorable determinant with regard to DFS and OS. Further multivariate analysis also confirmed that LDH was an independent predictor for DFS and OS. Additionally, N status and age were also found to be significantly associated with both DFS and OS.ConclusionPretreatment elevated serum LDH is an inferior prognostic factor for patients with hypopharyngeal cancer. These results should be validated by more multicenter and prospective studies.

Optimally Debulked Stage III Ovarian Cancer: Intraperitoneal or Intravenous Chemotherapy?

2010 ◽  
Vol 20 (Suppl 2) ◽  
pp. S20-S23 ◽  
Author(s):  
Michael Friedlander
Keyword(s):  
Ovarian Cancer ◽  
Systemic Chemotherapy ◽  
Gynecologic Oncology ◽  
Standard Of Care ◽  
Stage Iii ◽  
Gynecologic Oncology Group ◽  
Optimal Management ◽  
Intravenous Chemotherapy ◽  
Dose Dense

The optimal management of women with optimally debulked stage III ovarian cancer is contentious. There are in particular widely differing views regarding the role of intraperitoneal chemotherapy, and this has been debated widely. Being on the negative side in the debate, I will provide compelling reasons why systemic chemotherapy should remain the standard of care but argue that dose-dense weekly paclitaxel rather than the 3 weekly schedules should be adopted based on the results of the Japanese Gynecologic Oncology Group study. The pharmacokinetics of intraperitoneal paclitaxel suggests that intraperitoneal paclitaxel at day 8 with intravenous paclitaxel at day 1 is only a more complicated way of delivering dose-dense paclitaxel.

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