L. Gonzalez-Bayon

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of peritoneal surface malignancies of colonic origin: A consensus statement

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of peritoneal surface malignancies of colonic origin : a consensus statement

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of peritoneal surface malignancies of colonic origin: a consensus statement. Society of Surgical Oncology.

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of peritoneal surface malignancies of colonic origin : a consensus statement

Accuracy and clinical relevance of computed tomography scan interpretation of peritoneal cancer index in colorectal cancer peritoneal carcinomatosis: A multi‐institutional study

Evaluation of peritoneal metastases by computed tomography (CT) scans is challenging and has been reported to be inaccurate.

Hyperthermic Intraperitoneal Chemotherapy: Methodology and Safety Considerations

Several methods of delivering hyperthermic intraperitoneal chemotherapy (HIPEC) during the course of cytoreductive surgery have been described, but no significant differences in treatment results have been found among them. HIPEC is a safe treatment for the patient and for healthcare workers involved in the procedure provided standard protective and environmental measures are used. This article describes the different techniques in use and the technology available for the administration of HIPEC. Also reviewed are the safety features that must be taken into consideration when performing this procedure. Recommended guidelines to prevent associated occupational hazards are provided.

Prognostic Impact of External Beam Radiation Therapy in Patients Treated With and Without Extended Surgery and Intraoperative Electrons for Locally Recurrent Rectal Cancer: 16-Year Experience in a Single Institution

PURPOSE To analyze prognostic factors associated with survival in patients after intraoperative electrons containing resective surgical rescue of locally recurrent rectal cancer (LRRC). METHODS AND MATERIALS From January 1995 to December 2011, 60 patients with LRRC underwent extended surgery (n=38: multiorgan [43%], bone [28%], soft tissue [38%]) or nonextended (n=22) surgical resection, including a component of intraoperative electron-beam radiation therapy (IOERT) to the pelvic recurrence tumor bed. Twenty-eight (47%) of these patients also received external beam radiation therapy (EBRT) (range, 30.6-50.4 Gy). Survival outcomes were estimated by the Kaplan-Meier method, and risk factors were identified by univariate and multivariate analyses. RESULTS The median follow-up time was 36 months (range, 2-189 months), and the 1-year, 3-year, and 5-year rates for locoregional control (LRC) and overall survival (OS) were 86%, 52%, and 44%; and 78%, 53%, 43%, respectively. On multivariate analysis, R1 resection, EBRT at the time of pelvic rerecurrence, no tumor fragmentation, and non-lymph node metastasis retained significance with regard to LRR. R1 resection and no tumor fragmentation showed a significant association with OS after adjustment for other covariates. CONCLUSIONS EBRT treatment integrated for rescue, resection radicality, and not involved fragmented resection specimens are associated with improved LRC in patients with locally recurrent rectal cancer. Additionally, tumor fragmentation could be compensated by EBRT. Present results suggest that a significant group of patients with LRRC may benefit from EBRT treatment integrated with extended surgery and IOERT.

Surgery and intraoperative electron radiotherapy in recurrent or metastatic oligotopic extrapelvic cancer: Long-term outcome

PURPOSE To evaluate the feasibility and long-term outcome of surgery combined with intraoperative electron radiotherapy (IOERT) as rescue treatment in patients with recurrent and/or metastatic oligotopic extrapelvic cancer. METHODS AND MATERIALS From April 1996 to April 2010, we treated 28 patients using 34 IOERT procedures. The main histopathology findings were adenocarcinoma (39%) and squamous cell carcinoma (29%). The original cancer sites were gynecologic (67%), urologic (14%) and colorectal (14%). The location of recurrence was the para-aortic region in 53.5% of patients. RESULTS Median follow-up was 39 months (1-84 months), during which time 14% of patients experienced local recurrence and 53.5% developed distant metastasis. Overall survival at 2 and 5 years was 57% and 35% respectively. At the time of the analysis, 13 patients were alive, 6 for more than 55 months of follow-up. Local control was not significantly affected by the following histopathologic characteristics of the resected surgical specimen: number of fragments submitted for pathology study (1 to >6), maximal tumor dimension (≤ 2 to ≥ 6 cm), rate of involved nodes (0-100%) and involved resection margin (local recurrence 23% vs 7%; p = 0.21). Local recurrence was significantly affected by microscopic cancer in more than 50% of specimen fragments (38% vs 9%, p = 0.02). CONCLUSIONS IOERT for recurrence of oligotopic extrapelvic cancer increased long-term survival in patients with controlled cancer and appears to compensate for some adverse prognostic features in local control. Individualized treatment strategies for this heterogeneous category of patients with recurrent cancer will make it possible to optimize results.

Tumores sacropélvicos primarios y secundarios. Tratamiento con cirugía radical y radioterapia intraoperatoria

Resumen Introduccion La reseccion sacropelvica es el tratamiento de eleccion de los tumores primitivos o secundarios de los huesos pelvicos. Sin embargo, es una tecnica compleja asociada a una elevada tasa de recidiva local. Para optimizar el control local y la supervivencia proponemos la asociacion de radioterapia intraoperatoria (RIO) a la cirugia radical. Pacientes y metodo Desde 1997-2002 hemos evaluado a 17 pacientes, de los que 15 fueron operados. En 13 casos se realizo sacrectomia (siete por invasion de cancer de recto, tres por cordomas sacros, uno por histiocitoma maligno, uno por neurofibrosarcoma y uno por condrosarcoma). En 2 pacientes se llevo a cabo una escision subtotal del ilion izquierdo y del pubis por sarcomas de la region. En 7 casos se practicaron procedimientos asociados (3 exenteraciones pelvicas completas, 2 posteriores y 2 resecciones intestinales). En todos los casos se aplico un componente de RIO sobre el area de reseccion, con dosis entre 10-12,5 Gy. Resultados Un paciente murio (6,5%) en el postoperatorio inmediato por infarto agudo de miocardio. Las complicaciones mayores incluyeron dos reoperaciones y 7 infecciones o retraso en la curacion de la herida pelviperineal. El seguimiento medio ha sido de 26 meses (rango, 6-60 meses). Dos pacientes presentaron una recaida sistemica con metastasis a distancia, sin recidiva local, a los 41-48 meses de la cirugia. Los otros 13 pacientes siguen vivos, sin evidencia de enfermedad, a los 6-60 meses de la intervencion quirurgica. Conclusiones La invasion tumoral sacropelvica no debe ser considerada como signo de inoperabilidad. La prolongada supervivencia con control de los sintomas locales en el 86% de nuestros pacientes sometidos a cirugia radical y RIO avalan esta terapia multimodal. El presente articulo contribuye a la descripcion de las indicaciones de reseccion sacropelvica, los tiempos tecnicos y los resultados a medio plazo. Consideramos que la RIO durante la cirugia radical ha sido de gran importancia para el control local de la enfermedad. Segun nuestro conocimiento, esta es la primera descripcion en Espana de una serie clinica de reseccion sacropelvica asociada a radioterapia intraoperatoria.

Erratum: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of peritoneal surface malignancies of colonic origin: A consensus statement (Annals of Surgical Oncology 14 (128-133)DOI: 10.1245/s10434-006-9185-7)

J. Esquivel, R. Sticca, P. Sugarbaker, E. Levine, T. D. Yan, R. Alexander, D. Baratti, D. Bartlett, R. Barone, P. Barrios, S. Bieligk, P. Bretcha-Boix, C. K. Chang, F. Chu, Q. Chu, S. Daniel, E. deBree, M. Deraco, L. Dominguez-Parra, D. Elias, R. Flynn, J. Foster, A. Garofalo, F. N. Gilly, O. Glehen, A. Gomez-Portilla, L. Gonzalez-Bayon, S. Gonzalez-Moreno, M. Goodman, V. Gushchin, N. Hanna, J. Hartmann, L. Harrison, R. Hoefer, J. Kane, D. Kecmanovic, S. Kelley, J. Kuhn, J. LaMont, J. Lange, B. Li, B. Loggie, H. Mahteme, G. Mann, R. Martin, R. A. Misih, B. Moran, D. Morris, L. Onate-Ocana, N. Petrelli, G. Philippe, J. Pingpank, A. Pitroff, P. Piso, M. Quinones, L. Riley, L. Rutstein, S. Saha, S. Alrawi, A. Sardi, S. Schneebaum, P. Shen, D. Shibata, J. Spellman, A. Stojadinovic, J. Stewart, J. Torres-Melero, T. Tuttle, V. Verwaal, J. Villar, N. Wilkinson, R. Younan, H. Zeh, F. Zoetmulder, and G. Sebbag

OC-0480: External radiation therapy, extended surgery and intraoperative electrons for oligorrecurent pelvic cancer

Purpose/Objective: To analyze prognostic factors associated with survival in patients after intensified radio-surgical rescue of oligorecurrent pelvic cancer, particularly the influence of external beam radiation therapy (EBRT). Materials and Methods: From January 1995 to december 2011, 81 patients [colorectal (46%); gynecologic (26%); retroperitoneal sarcoma (18%)] underwent extended surgery [multiorgan (58%), bone (23%), vascular (9%), soft tissue (43%)] and intraoperative electron-beam radiation therapy [IOERT (10-15 Gy)] to the pelvic recurrence tumor bed. 35 (43%) of these patients also received EBRT (30.6-50.4 Gy). Survival outcomes were estimated using the Kaplan-Meier method, and risk factors were identified by univariate and multivariate analyses. Results: Median follow-up was 34 months (3-189 months), and the 13-, and 5-year rates of locoregional control (LRC) were 83%, 53%, and 41%, respectively. Univariate Cox proportional hazard analysis revealed worse LRC for those patients who did not received integrated EBRT treatment for the pelvic recurrence rescue (p=0.003), and had non-radical resection (p=0.01). On multivariate analysis, integrated EBRT treatment, non-radical resection, and tumor fragmentation retained significance (p=0.002,p=0.004, and p=0.05, respectively). Conclusions: EBRT treatment integrated for rescue, radical resection, and abscence of tumor fragmentation are associated with improved LRC in patients with oligorecurrent pelvic cancer. Present results suggest that patients with oligorecurrent pelvic disease ma ybenefit from EBRT treatment integrated with extended surgery and IOERT.

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of peritoneal surface malignancies of colonic origin

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of peritoneal surface malignancies of colonic origin : a consensus statement