Evaluation of non-completion of intraperitoneal chemotherapy in patients with advanced epithelial ovarian cancer / 부인종양

OBJECTIVE: To identify factors associated with non-completion of intraperitoneal with intravenous chemotherapy [IP/IV] in women with epithelial ovarian cancer (EOC). METHODS: This was an Institutional Review Board approved, retrospective cohort study in women with stage III EOC following optimal cytoreductive surgery (CRS) (<1 cm) followed by IP/IV chemotherapy from 2000–2016. Demographic, surgical, and oncologic variables were collected. Pearson χ2 test and 2 sample t-test evaluated for variables associated with IP/IV chemotherapy completion. Kaplan-Meier survival analysis was performed for progression-free survival (PFS) and overall survival (OS). RESULTS: Of 96 women, 71.9% (n=69) completed 6 cycles of IP/IV chemotherapy. The majority had high grade serous histology (n=82; 85.4%) and stage IIIC disease (n=83; 86.5%). Common reasons for IP/IV chemotherapy discontinuation were grade 3–4 gastrointestinal (n=10; 37.0%), neurologic (n=6; 22.2%), hematologic (n=3; 11.1%), renal toxicities (n=3; 11.1%) and port infections (n=3; 11.1%). Incidence of IP port complications was 20.8% (n=20). Port complications (48.0% vs. 11.6%; p<0.001) and hospitalization during chemotherapy (29.6% vs. 2.9%; p<0.001) were more frequent in patients who discontinued IP/IV chemotherapy. Patients who completed IP/IV chemotherapy had higher rates of home discharge following CRS (92.2% vs. 72.0%; p<0.01) and lower Eastern Cooperative Oncology Group (ECOG) score (0 vs. 1.0; p=0.04). There was no significant difference in PFS (p=0.51) nor OS (p=0.38) between the cohorts. CONCLUSION: In this series, the rate of IP/IV chemotherapy completion is high. Non-home discharge and higher ECOG status following CRS are associated with IP/IV chemotherapy non-completion and should be considered in treatment planning.

Terapia intraperitoneal paliativa en ascitis maligna fîlcrossMark refractaria / Intraperitoneal palliative therapy in refractory malignant ascites

Resumen El tratamiento convencional de la ascitis maligna refractaria es un reto oncológico pues provee mejoría sintomática poco duradera. La terapia intraperitoneal ha sido evaluada principalmente en reportes y series de casos, y en algunos ensayos clínicos, estudiados principalmente en la ascitis por cáncer ovárico y gastrointestinal. Esta terapia incluye: isótopos radioactivos, quimioterapia con hipertermia y sin esta, terapia inmunológica, biológica y otras. Los tratamientos más exitosos con respuestas variables, y aunque la comparación directa no es posible, son: la quimioterapia intraperitoneal hipertérmica (respuesta global entre 85,7% y 100%) y el catumaxomab, que frente a la paracentesis demostró una supervivencia libre de punción de 46 vs 11 días (HR 0,254) y una mediana a la próxima paracentesis de 77 vs 13 días (HR 0,169), con impacto positivo en la calidad de vida, principal fin en el escenario paliativo. La investigación en este campo continúa buscando resultados más duraderos, seguros y costo-efectivos.

Abstract Conventional treatment of refractory malignant ascites is an oncological challenge since it provides little lasting symptomatic improvement. Intraperitoneal therapy, evaluated mainly through series and case reports, and some clinical trials include the use of radioisotopes, chemotherapy, with and without hyperthermia, immunological and biological therapy and others. It has been studied mainly in ascites from ovarian and gastrointestinal cancer. With variable response rates, and although direct comparison is not possible, the most successfully treatments are hyperthermic intraperitoneal chemotherapy (overall response rate between 85.7% and 100%), and catumaxomab, which compared to paracentesis, demonstrated a puncture-free survival of 46 vs. 11 days (HR 0.254) and a median time to next paracentesis of 77 vs. 13 days (HR 0.169). This had a positive impact on quality of life, which is the main goal in the palliative setting. Research in this field continues looking for more lasting, safe, and cost-effective results.

The primary clinic application of hyperthermic intraperitoneal chemotherapy (HIPEC) guided by B ultrasound in the treatment of malignant ascites / 实用医学杂志

Objective To investigate the measurement , feasibility and clinic effect of hyperthermic intraperitoneal chemotherapy (HIPEC) guided by B ultrasound in the treatment of malignant ascites from peritoneal carcinomatosis. Methods From July 2011 to June 2013, B ultrasound-guided approach was used to perform HIPEC on 36 patients affected by malignant ascites secondary to peritoneal carcinomatosis. Every patient underwent HIPEC for three times , by way of continuous circulatory perfusion into peritoneal cavity with saline at 400 ~ 600 mL/min and intraperitoneal perfusion with 5-FU mitomycin-C and cisplatin for 90 minutes with an inflow temperature of (43 ± 0.2)℃. These patients were followed up for a long term. Results Intraoperative course was uneventful in all cases. Complete clinical regression of ascites and related symptoms was achieved in all the 26 patients, partial regression achieved in 8 patients, and no curative effect achieved in 2 cases. The acquired total clinic effectiveness was 94.44%. No postoperative deaths and complication related to the procedure occurred in this study. The KPS grades of patients rose (P < 0.001), the level of tumor markers decreased, including CA199 (P < 0.001), CEA (P < 0.001), CA125 (P = 0.003). Conclusion HIPEC guided by B ultrasound appears to be a safe, feasible and effective procedure for the treatment of debilitating malignant ascites from unresectable peritoneal carcinomatosis , which would have a clinic good perspective in future.

Peritoneal Metastatic Goblet-Cell Carcinoid Tumor Treated With Cytoreductive Surgery and Intraperitoneal Chemotherapy

We report a case of a goblet-cell carcinoid tumor of the appendix which metastasized to the peritoneum and was treated by using cytoreductive surgery (CRS) with intraperitoneal chemotherapy. A 47-year-old male presented with chronic constipation and was diagnosed as having a rectal adenocarcinoma with a signet-ring-cell component under colonoscopy. Computed tomography suggested peritoneal metastases with diffuse nodular parietal peritoneal thickening of the entire abdomen and focal invasion of the upper rectum by a seeding mass. CRS with intraperitoneal chemotherapy was done under the diagnosis of a rectal adenocarcinoma with peritoneal metastases. The pathologic diagnosis was a goblet-cell carcinoid tumor of the appendix with peritoneal metastasis. The histological discrepancy between a peritoneal metastatic mass and a rectal mass was due to the mixed histological pattern of a goblet-cell carcinoid tumor. A metastatic mass may not share identical immunohistochemical characteristics from its origin. This histologic discrepancy necessitates caution in diagnosing a distant metastasis of a goblet-cell carcinoid tumor.