Peritoneal Carcinomatosis

Mura G, Verdelli B. The features of peritoneal metastases from gastric cancer. J Cancer Metastasis Treat 2016;2:365-74. Peritoneal Carcinomatosis (PC) from metastasization of Gastric Cancer (GC), either present at first diagnosis of GC or as recurrence, is considered a fatal disease with no hope of definitive cure. Although newer agents like S1 and docetaxel have shown some promise, the median overall survival with the current first line chemotherapy is only 8 to 14 months, and is not greatly improved by adding targeted therapy. A multi-modal approach with cytoreductive surgery (CRS) associated with hyperthermic intraperitoneal chemotherapy (HIPEC) has been developed along the last two decades in order to tackle this problem. It's an aggressive, combined treatment still under investigation. Studies coming from Europe and Far East reported long-term survival with 5-year survival rates up to nearly 25% in case of complete cytoreduction. Prophylactic/adjuvant setting is the most evidence-based indication for HIPEC in advanced-stage GC patients without PC, in order to prevent peritoneal recurrence and to improve overall survival. The rationale for immuno treatment in patients with gastric PC is strong. A randomized phase II study, combining complete CRS with intraperitoneal catumaxomab is ongoing. The detection of free peritoneal cancer cells is the more realistic and practical way for the identification of patients at risk of carcinomatosis after surgery. The routine use of techniques of molecular detection in peritoneal washing appears to be the more sensitive method. Such patients are potential candidate for multimodal and locoregional treatments in order to prevent the peritoneal recurrence.

Aims and objectives: The aim of this paper was to study the impact of neoadjuvant chemoradiation on downstaging of locally advanced rectal carcinoma, sphincter saving procedures and toxicity profile of chemoradiation.
Method: 31 patients were studied who had locally advanced adenocarcinoma of rectum. They were treated preoperatively with 20 frations of 225 cGy (5 days/wk) radiation (total of 45Gy over 28 days). Chemotherapy consisted of 5-FU (500mg/m.sq) only for day 1, 2, & 3. After an interval of of 4-6 wks, all patients were submitted to surgery.The principles of TME was
Results: The median follow up in our study was 1year. At 1 year the overall survival in operated cases was 100% with no disease relapse. 67% of patients underwent low anterior resection,6.5% had proctosigmoidectomy with end colostomy,16.5% had a palliative surgical procedure, 6.5% became non compliant after neoadjuvant and 3.2% expired preoperatively during chemoradiation. At the time of surgery 82.6% of patients had pathological downstaging of tomour and 45.4% had lymphnode downstaging.Consequently 67.7% of patients underwent a sphincter preserving surgical procedure.
The incidence of complication was 29% with grade 2 mucositis and 9.7% with grade 1 mucositis. Myelosuppression was seen in non.
Conclusion: Significant downstaging of disease was seen with this regime of treatment and with improved subsequent sphincterv preserving procedures with acceptable toxicity profile.

The purpose of our study was to evaluate initial results following introduction of Hyperthermic Intraperitoneal Chemotherapy (HIPEC) and Cytoreductive Surgery (CS). Twenty two patients with intraperitoneal malignancy undergone cytoreductive surgery (CS) and hyperthermic intraoperative chemotherapy (HIPEC) between January of 2007 and January 2010. Nine patients had adenocarcinoma of colorectal origin, 8 patients had ovarian cancer, and 5 had pseudomyxoma peritonei. Inclusion criteria were diagnosis of peritoneal carcinomatosis based on intraoperative assessment during first operative procedure for intraabdominal malignancy or follow-up diagnostic imaging proof. Excluded were patients with known malignant proliferation outside abdomen, liver metastasis and ASA score 4 and higher. All patients with pseudomyxoma peritonei diagnosis are alive, with mean follow-up time 24.8 months (range 15–35). In group of patients with adenocarcinoma from colorectal origin, 3 died, resulting in mean survival time 7.6 months (range 1–16). In group of patients with ovarian cancer, 2 died, resulting in mean survival time 13.8 months (range 0–31). Two patients died in early postoperative period. Most of the patients had some sort of mental disorder. Although HIPEC with CS improves
survival, during introduction period higher morbidity and mortality could be expected.

Based on the importance of assessing the true extent of peritoneal disease, PeRitOneal MalIgnancy Stage Evaluation (PROMISE) internet application (www.e-promise.org) has been developed to facilitate tabulation and automatically calculate surgically validated peri-toneal cancer index (PCI), and other surgically validated scores as Gilly score, simplified peritoneal cancer index (SPCI), Fagotti and Fagotti-modified scores. This application offers computer-assistance to produce simple, quick but precise and standardized pre, intra and postoperative reports of the extent of peritoneal metastases and may help specialized and non-specialized institutions in their current practice but also facilitate research and multicentre studies on peritoneal surface malignancies. Please cite this article in press as: Villeneuve L, et al., A new internet tool to report peritoneal malignancy extent. PeRitOneal MalIgnancy Stage Evaluation (PROMISE) application, Eur J Surg Oncol (2016), http://dx.

El olaparabib es un agente antineoplásico que actúa como inhibidor de varios isoenzimas (1, 2 y 3) de la familia de las PARP (poli-ADP-ribosa polimerasas), implicadas en los mecanismos de reparación del ADN, tanto en células normales como neoplásicas. El olaparib actúa selectivamente sobre líneas celulares con BRCA mutante o con baja expresión BRCA, especialmente con respecto al BRCA2. Ha sido autorizado como medicamento huérfano para la monoterapia para el tratamiento de mantenimiento de pacientes adultas con cáncer de ovario epitelial seroso de alto grado, trompa de Falopio, o peritoneal primario, con mutación BRCA (germinal y/o somática), sensible a platino, en recaída, que están en respuesta (respuesta completa o parcial) a quimioterapia basada en platino. Los datos clínicos disponibles indican que el medicamento es capaz de prolongar significativamente 3,6 meses la supervivencia de las pacientes en ausencia de progresión tumoral con relación al placebo, periodo que llega a los 6,9 meses en el caso de aquellas con estatus BRCA mutante.

Background: Peritoneal carcinomatosis is life-threatening without cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy (PIC). Only a few studies in the literature addressed the relationship between age and outcomes of peritonectomy. This study was designed to review the clinical outcomes in elderly patients who underwent CRS and PIC. Methods: This is a retrospective study of prospectively collected data of 611 consecutive patients with peritoneal carcinomatosis who underwent CRS and PIC by the same surgical team at St George Hospital in Sydney, Australia, between January 1996 and December 2013. Patients were divided into two groups; group 1 (<65 years old, n = 487) and group 2 (≥ 65 years old, n = 124). Subgroup analysis was performed in patients who were ≥75 years old (n = 20). A significant difference was defined as p < 0.05. Results: There was no significant statistical difference in terms of mean total hospital stay, intensive care unit stay, high dependency unit stay and complication rates. Postoperative mortality was 2 and 3 % in groups 1 and 2, respectively. Overall survival did not reach a statistical significance between the two groups. In subgroup analysis, patients showed similar morbidity results to patients who were <65 years old. Conclusions: CRS and PIC can be safely done in the elderly. Age alone should not be the single exclusion criterion but rather taken into consideration along with other factors to determine the suitability of elderly patients.

Background:  Pioglitazone  is  widely  prescribed  oral
hypoglycaemic  thiazolidinediones  acting  through  Peroxisome
Proliferators  Activated  Receptor  gamma  (PPAR  ƴ)  as  agonist.
Apart  from  potent  anti-hyperglycaemic  action  by  improving
insulin sensitivity, it also has positive effects on lipid metabolism
and endothelial function. Controversies about use of Pioglitazone
have  been  raised  with  regard  to  risk  of  bladder  cancer.  Hence recently drug was banned in India, but again ban was revoked for its use with special precautions. So there is a lot  of debate about benefit  to  risk  ratio  of  this  drug.  With  this  background  we  are presenting  a  case  of  carcinoma  of  urinary  bladder  developed  in type  2  diabetes  mellitus  (T2DM)  patient  who  was  receiving Pioglitazone for glycemic control.
Case presentation: A  65 year old man was admitted to our centre
for tumor in urinary bladder. He was diagnosed as a case T2DM 8
year’s  back  at  his  village  and  started  therapy  with  Metformin.
After  2  years  Pioglitazone  was  added  for  glycemic  control.  He received Pioglitazone in combination with Metformin for 6 years and  then  diagnosed  urinary  bladder  cancer.  First  we  shifted  him from Pioglitazone to Mixtard Humiinsulin therapy. We  managed him  by  transurethral  resection  of  bladder  tumour  followed  by  6 cycles  of  intravesical  Mitomycin  40  mg  weekly  chemotherapy regimen.  After  completion  of  total  treatment  he  is  in  remission period for 11 months.
Conclusion:  To  study  long  term  safety  of  Pioglitazone,  large
population based prospective studies are required. But till that time physicians should pay careful attention to assess the possibility of bladder cancer in patients receiving Pioglitazone.

While developing the idea and technical details of my Laparoscopy-Enhanced HIPEC technique (LE-HIPEC) I was surprised by the rising number of observations and thoughts that came to light.
I decided to write these notes to fix those thoughts and use them to help me and anyone who is interested to investigate the different aspects of my idea.
I want to clarify that many of the considerations that you will find here are just my assumptions that need to be confirmed by properly designed studies.
I hope these notes will help to further understand the principles and aims of the LE-HIPEC technique.