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Clinical Studies in Peritoneal Surface Malignancies

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A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Clinical Research of Cancer".

Deadline for manuscript submissions: closed (1 November 2022) | Viewed by 11189

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Special Issue Editors

Prof. Dr. Martin Hübner

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Guest Editor

Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Rue du Bugnon 46, 1011 Lausanne, Switzerland
Interests: colorectal surgery; proctology; minimal invasive surgery; peritoneal carcinoma; HIPEC; PIPAC
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Nicolas Demartines

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Guest Editor

Department of Visceral Surgery, Lausanne University Hospital, 1011 Lausanne, Switzerland
Interests: hepato-biliary and pancreas surgery; oncologic surgery; upper GI surgery

Special Issue Information

Dear Colleagues,

Peritoneal surface malignancies (PSM) comprise a heterogeneous group of primary peritoneal cancers (PC; e.g., mesothelioma) and peritoneal metastases (PM) of different primaries, mostly of ovarian, gastric, colorectal, appendicular and pancreatic origin. For a longtime, PSM have been associated with very bad prognosis due to late diagnosis and limited treatment options. Advanced imaging modalities and increasing use of diagnostic laparoscopy have led to earlier detection and multimodal treatments have changed the prognosis of PSM considerably over the last decade. The backbone of multimodal treatments are combined modern systemic chemotherapy and complete cytoreductive surgery which is frequently combined with intraperitoneal chemotherapy (IP). The latter has also become an interesting alternative in the palliative and neoadjuvant setting.

The present Special Issue aims to provide a comprehensive overview over ongoing and completed clinical studies on the treatment for PSM. We invite not only RCTs and prospective studies but also registry data, trial protocols and large-scale retrospective studies. Submission of studies in the palliative setting and assessment of alternative patient-centered endpoints such as QoL, PROMs and PREMs are explicitly encouraged.

The ultimate aim and common path for eligible papers should be the optimization of treatments and care for patients with PSM.

Prof. Dr. Martin Hübner
Prof. Dr. Nicolas Demartines
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

peritoneal surface malignancies
peritoneal metastases
peritoneal cancer
treatment/surgery/chemotherapy/intraperitoneal chemotherapy
outcomes/survival/complications/quality of life
clinical studies/trials/comparative studies

Published Papers (5 papers)

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Research

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17 pages, 6440 KiB

Open AccessArticle

The SAlzburg PEritoneal SUrface CAlculator (SAPESUCA): The First Web-Based Application for Peritoneal Surface Area Quantification

by Tarkan Jäger, Philipp Schredl, Daniel Neureiter, Jaroslav Presl, Peter Tschann, Ingmar Königsrainer, Andreas Pascher, Klaus Emmanuel, Stephan Regenbogen and Jan Philipp Ramspott

Cancers 2023, 15(12), 3134; https://doi.org/10.3390/cancers15123134 - 10 Jun 2023

Viewed by 1437

Abstract

(1) Background: Peritoneal metastasized colorectal cancer is associated with a worse prognosis. The combination of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) showed promising results in selected patients, but standardization is lacking so far. We present the first tool enabling standardized peritoneal surface area (PSA) quantification in patients undergoing CRS and HIPEC: The SAlzburg PEritoneal SUrface CAlculator (SAPESUCA). (2) Methods: SAPESUCA was programmed using the R-Shiny framework. The application was validated in 23 consecutive colon cancer patients who received 27 closed oxaliplatin-based HIPECs between 2016 and 2020. The programming algorithm incorporates the patient’s body surface area and its correlated peritoneal surface area (PSA) based on the 13 Peritoneal Cancer Index (PCI) regions. (3) Results: Patients’ median age was 56 years. Median PCI was 9. SAPESUCA revealed a mean PSA of 18,613 cm² ± 1951 of all patients before compared to 13,681 cm² ± 2866 after CRS. The Central PCI region revealed the highest mean peritonectomy extent (1517 cm² ± 737). The peritonectomy extent correlated significantly with PCI score and postoperative morbidity. The simulated mean oxaliplatin dose differed significantly before and after CRS (558 mg/m² ± 58.4 vs. 409 mg/m² ± 86.1; p < 0.0001). (4) Conclusion: SAPESUCA is the first free web-based app for standardized determination of the resected and remaining PSA after CRS. The tool enables chemotherapeutic dose adjustment to the remaining PSA. Full article

(This article belongs to the Special Issue Clinical Studies in Peritoneal Surface Malignancies)

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15 pages, 2310 KiB

Open AccessArticle

Assessment of Treatment Response after Pressurized Intra-Peritoneal Aerosol Chemotherapy (PIPAC) for Appendiceal Peritoneal Metastases

by SP Somashekhar, Julio Abba, Olivia Sgarbura, Mohammad Alyami, Hugo Teixeira Farinha, Ramya G. Rao, Wouter Willaert and Martin Hübner

Cancers 2022, 14(20), 4998; https://doi.org/10.3390/cancers14204998 - 12 Oct 2022

Cited by 4 | Viewed by 1485

Abstract

Background The aim of this study was to analyse survival and surrogates for oncological response after PIPAC for appendiceal tumours. Methods This retrospective cohort study included consecutive patients with appendiceal peritoneal metastases (PM) treated in experienced PIPAC centers. Primary outcome measure was overall survival (OS) from the date of diagnosis of PM and from the start of PIPAC. Predefined secondary outcome included radiological response (RECIST criteria), repeat laparoscopy and peritoneal cancer index (PCI), histological response assessed by the Peritoneal regression grading system (PRGS) and clinical response. Results Final analysis included 77 consecutive patients (208 PIPAC procedures) from 15 centres. Median OS was 30 months (23.00–46.00) from time of diagnosis and 19 months (13.00–28.00) from start of PIPAC. 35/77 patients (45%) had ≥3 procedures (pp: per protocol). Objective response at PIPAC3 was as follows: RECIST: complete response 4 (11.4%), 11 (31.4%) partial/stable; mean PRGS at PIPAC3: 1.8 ± 0.9. Median PCI: 21 (IQR 18–27) vs. 22 (IQR 17–28) at baseline (p = 0.59); 21 (60%) and 18 (51%) patients were symptomatic at baseline and PIPAC3, respectively (p = 0.873). Median OS in the pp cohort was 22.00 months (19.00–NA) from 1st PIPAC. Conclusion Patients with PM of appendiceal origin had objective treatment response after PIPAC and encouraging survival curves call for further prospective evaluation. Full article

(This article belongs to the Special Issue Clinical Studies in Peritoneal Surface Malignancies)

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16 pages, 10392 KiB

Open AccessArticle

Prospective Comparison of the Performance of MRI Versus CT in the Detection and Evaluation of Peritoneal Surface Malignancies

by Claramae Shulyn Chia, Louis Choon Kit Wong, Tiffany Priyanthi Hennedige, Whee Sze Ong, Hong-Yuan Zhu, Grace Hwei Ching Tan, Jin Wei Kwek, Chin Jin Seo, Jolene Si Min Wong, Chin-Ann Johnny Ong, Choon Hua Thng, Khee Chee Soo and Melissa Ching Ching Teo

Cancers 2022, 14(13), 3179; https://doi.org/10.3390/cancers14133179 - 29 Jun 2022

Cited by 7 | Viewed by 2180

Abstract

Background: The performance of MRI versus CT in the detection and evaluation of peritoneal surface malignancies (PSM) remains unclear in the current literature. Our study is the first prospective study in an Asian center comparing the two imaging modalities, validated against intra-operative findings. Methods: A total of 36 patients with PSM eligible for CRS-HIPEC underwent both MRI and CT scans up to 6 weeks before the operation. The scans were assessed for the presence and distribution of PSM and scored using the peritoneal cancer index (PCI), which were compared against PCI determined at surgery. Results: Both MRI and CT were 100% sensitive and specific in detecting the overall presence of PSM. Across all peritoneal regions, the sensitivity and specificity for PSM detection was 49.1% and 93.0% for MRI, compared to 47.8% and 95.1% for CT (p = 0.76). MRI was more sensitive than CT for small bowel disease, although the difference did not reach statistical significance. Comparing PCI on imaging with intra-operative PCI, the mean difference was found to be −3.4 ± 5.4 (p < 0.01) for MRI, and −3.9 ± 4.1 (p < 0.01) for CT. The correlation between imaging and intra-operative PCI was poor, with a concordance coefficient of 0.76 and 0.79 for MRI and CT, respectively. Within individual peritoneal regions, there was also poor agreement between imaging and intra-operative PCI for both modalities, other than in regions 1 and 3. Conclusion: MRI and CT are comparable in the detection and evaluation of PSM. While sensitive in the overall detection of PSM, they are likely to underestimate the true disease burden. Full article

(This article belongs to the Special Issue Clinical Studies in Peritoneal Surface Malignancies)

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8 pages, 582 KiB

Open AccessArticle

Selection Criteria for Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) Treatment in Patients with Peritoneal Metastases

by Aurélie Balmer, Daniel Clerc, Laura Toussaint, Olivia Sgarbura, Abdelkader Taïbi, Martin Hübner and Hugo Teixeira Farinha

Cancers 2022, 14(10), 2557; https://doi.org/10.3390/cancers14102557 - 23 May 2022

Cited by 7 | Viewed by 2643

Abstract

Background: The standard treatment protocol for PIPAC consists of three procedures. Completion of treatment has been shown to be prognostic of improved survival. The aim of this study was to identify predictors for completion of treatment. Methods: Retrospective multicentric cohort study of patients with peritoneal metastases undergoing PIPAC in three PIPAC expert centers. Per protocol (PP) treatment was defined as patients receiving ≥3 PIPACs and was compared to patients receiving <3. Results: Overall, 183 patients had 517 PIPACs. The main reasons for stopping PIPAC were disease progression in 50% patients, bowel obstruction in 15%, patient’s refusal to pursue in 10%, conversion to cytoreductive surgery in 7%, and medical reasons in 8%. Overall, 95 patients (52%) had PP treatment. The PP median OS was 17 vs. 7 months, p = 0.001. PP patients had r ascites (410 ± 100 mL vs. 960 ± 188 mL, p = 0.001), no prior history of bowel obstruction (12% vs. 24%, p = 0.028), and more bimodal treatment (39% vs. 13%, p < 0.001). After multiple regression, bimodal treatment was found as an independent predictive factor for completing PP (OR = 4.202, 95%CI [1.813, 10.630], p < 0.001), along with prior bowel obstruction (OR = 0.389, 95%CI [0.153, 0.920], p = 0.037). Conclusion: The absence of ascites and prior bowel obstruction can help to select patients suitable for PIPAC. Best results seem to be achieved when PIPAC is combined with systemic chemotherapy. Full article

(This article belongs to the Special Issue Clinical Studies in Peritoneal Surface Malignancies)

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18 pages, 2045 KiB

Open AccessGuidelines

Comprehensive Treatment Algorithms of the Swiss Peritoneal Cancer Group for Peritoneal Cancer of Gastrointestinal Origin

by Michel Adamina, Maxime Warlaumont, Martin D. Berger, Silvio Däster, Raphaël Delaloye, Antonia Digklia, Beat Gloor, Ralph Fritsch, Dieter Koeberle, Thibaud Koessler, Kuno Lehmann, Phaedra Müller, Ralph Peterli, Frédéric Ris, Thomas Steffen, Christian Stefan Weisshaupt and Martin Hübner

Cancers 2022, 14(17), 4275; https://doi.org/10.3390/cancers14174275 - 1 Sep 2022

Cited by 1 | Viewed by 2756

Abstract

Peritoneal cancer (PC) is a dire finding, yet in selected patients, long-term survival is possible. Complete cytoreductive surgery (CRS) together with combination immunochemotherapy is essential to achieve cure. Hyperthermic intraperitoneal chemotherapy (HIPEC) and pressurized intraperitoneal aerosol chemotherapy (PIPAC) are increasingly added to the multimodal treatment. The Swiss Peritoneal Cancer Group (SPCG) is an interdisciplinary group of expert clinicians. It has developed comprehensive treatment algorithms for patients with PC from pseudomyxoma peritonei, peritoneal mesothelioma, gastric, and colorectal origin. They include multimodal neoadjuvant treatment, surgical resection, and palliative care. The indication for and results of CRS HIPEC and PIPAC are discussed in light of the current literature. Institutional volume and clinical expertise required to achieve best outcomes are underlined, while inclusion of patients considered for CRS HIPEC and PIPAC in a clinical registry is strongly advised. The present recommendations are in line with current international guidelines and provide the first comprehensive treatment proposal for patients with PC including intraperitoneal chemotherapy. The SPCG comprehensive treatment algorithms provide evidence-based guidance for the multimodal care of patients with PC of gastrointestinal origin that were endorsed by all Swiss clinicians routinely involved in the multimodal care of these challenging patients. Full article

(This article belongs to the Special Issue Clinical Studies in Peritoneal Surface Malignancies)

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