D. Baratti

Multicystic peritoneal mesothelioma: outcomes and patho-biological features in a multi-institutional series treated by cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

AIMnThis retrospective multi-institutional study addresses the role of surgical cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment of multicystic peritoneal mesothelioma (MCPM). MCPM is an uncommon tumour with uncertain malignant potential and no current standard therapy. Additionally, poorly defined pathological and biological features of this disease were investigated.nnnMETHODSnTwelve patients with MCPM underwent 14 procedures of cytoreduction and HIPEC in two Italian referral centres. Nine patients had recurrent disease after previous debulking (one operation in six patients, two in two, four in one). Biological markers related to mesothelioma origin and clinical features were assessed by immunohistochemical studies.nnnRESULTSnMedian follow-up was 64 months (range 5-148). Optimal cytoreduction (residual tumour nodules ≤2.5 mm) was performed in all the procedures. One grade IV postoperative complication (NCI/CTCAE v.3.0) and no operative death occurred. All the patients are presently alive with no evidence of disease, including two patients who underwent the procedure twice, due to locoregional disease recurrence. Five- and ten-year progression-free survival was 90% and 72%, accounting for a. statistically significant difference (P = 0.0001) with progression-free survival following previous debulking surgery (median 11 months; range 2-31). All cases showed low proliferative activity assessed by mitotic rate and Ki-67 expression.nnnCONCLUSIONSnMCPM is a borderline tumour with a high propensity to local-regional recurrence. Definitive tumour eradication by means of cytoreduction and HIPEC seems more effective than debulking surgery in preventing disease relapse. Low mitotic rate and poor Ki-67 expression might be related to the peculiar behaviour of MCMP.

Uterine sarcoma treated by cytoreductive surgery and intraperitoneal hyperthermic perfusion: a feasiblity study

Summary The purpose of this study was to evaluate the feasibility and the outcome impact of cytoreductive surgery (CRS) followed by intraperitoneal hyperthermic perfusion (IPHP) in patients affected by uterine sarcoma (US). Ten US patients were treated with CRS+IPHP (closed technique, cisplatin+mitomycin C or cisplatin+doxorubicin). Median follow-up was 25 months (range: 2-61). Five patients received preoperative chemotherapy. Nine cases underwent optimal CRS. Five-year overall and progression-free survivals were 65% and 30%, respectively. There was no operative morbidity, nor mortality and nor toxicity. Six patients presented disease progression. CRS+IPHP proved feasible and safe, with encouraging outcome results, warranting confirmation by further prospective controlled trials.

Is Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy Justified for Biphasic Variants of Peritoneal Mesothelioma? Outcomes from the Peritoneal Surface Oncology Group International Registry

AbstractBackgroundCytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) has dramatically improved the survival of patients with epithelioid peritoneal mesothelioma. It is unknown if CRS/HIPEC is indicated for the more aggressive biphasic mesothelioma variant.nMethodsA retrospective analysis of the Peritoneal Surface Oncology Group International (PSOGI) registry including data from 33 centers was performed. Survival was reviewed based on mesothelioma type, completion of cytoreduction, and volume of disease.ResultsOverall, 484 of 1165 (41.5%) CRS/HIPEC procedures with complete CC0 and CC1 cytoreductions were analyzed; 450 (93%) procedures were performed for epithelioid mesotheliomas, while 34 (7%) were performed for biphasic mesotheliomas. For patients with CC0 resection, 5-year survival was 64.5 and 50.2% (median 7.8 and 6.8xa0years; pxa0=xa00.015) for epithelioid and biphasic mesotheliomas, respectively, while inclusion of CC1 resections in the analysis resulted in inferior 5-year survival of 62.9% and 41.6% (median 7.8 and 2.8xa0years; pxa0=xa00.0012), respectively. Incomplete CC2 resections for biphasic primaries resulted in a median survival of 4.3xa0months. Univariate analysis of the biphasic cohort indicated Peritoneal Cancer Index (PCI; pxa0=xa00.015), CC status of resection (pxa0<xa00.0001), and Ki67 (pxa0=xa00.04) as predictors of survival. Systemic chemotherapy before (pxa0=xa00.55) or after (pxa0=xa00.7) CRS/HIPEC did not influence survival. In multivariate analysis, only PCI (pxa0=xa00.03) and CC (pxa0=xa00.04) remained significant.ConclusionsLong-term survival is achievable in patients with low-volume biphasic mesothelioma after complete macroscopic cytoreduction. Biphasic peritoneal mesotheliomas should not be considered as an absolute contraindication for CRS/HIPEC if there is low-volume disease and if complete cytoreduction can be achieved.