Safety evaluation of prophylactic hyperthermic intraperitoneal chemotherapy in elderly patients with locally advanced gastric cancer / 中华老年医学杂志

Objective:To analyze the short-term effects of prophylactic intraperitoneal hyperthermic chemotherapy(HIPEC)on elderly patients diagnosed with gastric cancer.Methods:The study enrolled patients with gastric cancer who underwent curative gastrectomy combined with postoperative HIPEC at Beijing Hospital between January 2017 and September 2022.The patients were divided into two groups based on age: young patients(age <65 years, n=45)and elderly patients(age≥65 years, n=32). The study evaluated the safety of HIPEC prophylactic application in elderly patients with gastric cancer by comparing their clinicopathological data, postoperative recovery, complications, and laboratory tests with those of another group of patients.Results:The study found that the elderly patients had a higher rate of comorbidities and higher ASA scores compared to the younger patients.Additionally, the elderly patients received HIPEC treatment less frequently than the younger patients( P=0.030). The proportion of young patients receiving one, two, and three times of HIPEC treatment was 8.9%, 57.8%, and 33.3%, respectively, while the proportion of elderly patients receiving the same was 28.1%, 59.4%, and 12.5%, respectively.The study found no significant differences in pathological characteristics between the two groups, including tumor stage, type, location, and differentiation degree.Additionally, there was no difference in the proportion of laparoscopic gastrectomy, type of resection, combined resection, duration of the operation, and intraoperative blood loss between elderly and young patients.The rate of complications between the two groups was also not significantly different(20.0% vs.21.9%; P=0.100). The mean duration of hospitalization after radical gastrectomy was 14.0 days in the young group and 15.5 days in the elderly group, respectively( P=0.480). Conclusions:Elderly patients with gastric cancer treated with radical gastrectomy combined with HIPEC did not experience increased postoperative complications or hospital stay compared to young patients, suggesting that prophylactic HIPEC was safe and feasible for elderly patients with locally advanced gastric cancer, as evidenced by favorable postoperative recovery and laboratory tests.

International guidelines for the treatment of peritoneal cancer: clinical pathways of cytoreductive surgery plus intraperitoneal hyperthermic chemotherapy / 中国肿瘤临床

Peritoneal cancer originates from a wide range of tumor sources and is associated with poor prognosis. Standardized therapy is of great significance in the treatment for patients with peritoneal cancer. The Peritoneal Surface Oncology Group International (PSOGI) instituted guidelines for peritoneal metastases. This article uses the Chinese version, which is divided into four parts: preoperative evaluation, surgery, chemotherapy, and clinical pathway. The preoperative evaluation consists of preoperative computed tomography, prognostic evaluation model, diagnostic laparoscopic exploration, the peritoneal cancer index, and the cytoreduction score. Peritoneal cancer treatment primarily consists of comprehensive treatment with cytoreductive surgery (CRS) and intraperitoneal hyperthermic chemotherapy. However, complete CRS is the key to the long-term survival of patients. Peritoneal cancer chemotherapy generally includes perioperative chemotherapy and regional chemotherapy. Finally, this guide outlines the clinical pathways. The Chinese version of the guidelines was published under the permission of the Secretary-General of the PSOGI Executive Committee.

Mujer joven con hepatocarcinoma fibrolamelar metastásico; citorreducción y HIPEC: a propósito de un caso / Young woman with metastatic fibrolamellar hepatocarcinoma; cytoreductive surgery and HIPEC: a case report

Objetivo: Reportar un caso clínico de hepatocarcinoma fibrolamelar metastásico y su manejo multidisciplinario. Caso clínico: Paciente de 24 años de edad con dolor abdominal, distensión abdominal y fiebre. Se le realizó tomografía computarizada de abdomen donde se encontró tumoración hepática irregular. Se realizó laparotomía con evidencia de múltiples implantes en cavidad abdominal y se diagnosticó mediante estudio histopatológico hepatocarcinoma fibrolamelar metastásico. Se decidió realizar citorreducción más quimioterapia hipertérmica intraperitoneal (HIPEC). La sobrevida de la paciente fue de 11 meses. Discusión: El hepatocarcinoma fibrolamelar es un tumor raro. Aún no hay consenso sobre el mejor tratamiento en pacientes con metástasis que tengan buena funcionalidad. El manejo actual se basa en la quimioterapia sistémica y la resección quirúrgica en casos localizados. En el caso de nuestra paciente, la cirugía citorreductora más HIPEC se realizó con la intención de mejorar la supervivencia. Se necesita más evidencia para definir esta estrategia como tratamiento estándar.

Aim: To report a clinical case of metastatic fibrolamellar hepatocarcinoma and its multidisciplinary management. Case report: 24 year-old patient with abdominal pain, bloating and fever. A computed tomography of the abdomen was performed; an irregular hepatic tumor was found. A laparotomy was performed with evidence of multiple implants in the abdominal cavity and the histopathology report was metastatic fibrolamellar hepatocarcinoma. It was decided to perform cytoreductive surgery plus HIPEC. The patient's survival was 11 months. Discussion: Fibrolamellar hepatocarcinoma is a rare tumor. There is still no consensus on the treatment of choice in patients with metastases with good functionality status. Current management is based on systemic chemotherapy and surgical resection in localized cases. In the case of our patient, cytoreductive surgery plus HIPEC was performed with the intention of improving survival. More evidence is needed to define this strategy as standard treatment.

Clinical analysis of different intraperitoneal hyperthermic chemotherapy drugs in the treatment of advanced ovarian cancer / 实用医学杂志

Objective To explore short term curative effects and adverse reactions of two different kinds of intraperitoneal hyperthermic chemotherapy (IPHC) drugs in the treatment of advanced ovarian cancer after cytoreductive surgery.Methods 76 patients with advanced ovarian cancer in the Second Affiliated Hospital of Zhengzhou University from July 2013 to November 2015 were divided into two groups:single-drugs group of 36 patients (IPHC with 5-fluorouracil after cytoreductive surgery combined with intravenous chemotherapy),combined treatment group of 40 patients(IPHC with 5-fluorouracil and carboplatin after cytoreductive surgery combined with intravenous chemotherapy).Short term curative effects,postoperative clinical indicators and adverse reactions of chemotherapy in two groups were compared and analyzed.Results The CA125 effective rates in single-drugs and combined treatment group were 86.11％ and 95％,and the difference showed statistically significant differences (P ＞ 0.05).The ascites remission rates in single-drugs and combined treatment group were 97.22％ and 97.5％,and the difference between two groups showed no statistically significant differences (P ＞ 0.05).Adverse drug reactions showed statistical difference in distribution of the bone marrow,liver damage and gastrointestinal toxicity.No statistical difference were found between the two groups in terms of distribution of renal damage and cardiovascular system damage.Conclusion IPHC after cytoreductive surgery in the treatment of advanced ovarian cancer is an effective means as adjuvant chemotherapy.The short-term curative effect of combined treatment group is obvious and adverse reactions can be tolerated.IPHC can be applied according to the patient's specific clinical situation.

Rol de la cirugía citoreductora y quimioterapia hipertérmica en el tratamiento de la carcinomatosis peritoneal / Cytoreductive surgery and hyperthermic chemotherapy role in peritoneal carcinomatosis treatment

El objetivo de este artículo es ofrecer una revisión sobre algunas estrategias terapéuticas actuales para pacientes con carcinomatosis peritoneal (CP), la que históricamente ha sido considerada como una condición terminal, sólo susceptibles de tratamientos y cuidados paliativos; y ocasionalmente de qui-mioterapia sistémica aislada con mala respuesta y supervivencias promedio inferiores a los 6 meses. La combinación de cirugía de citoreductora (CCR), que implica peritonectomía y resecciones multiviscerales con hipertermia y quimioterapia intraperitoneal intraoperatoria (HIPEC), es un concepto relativamente nuevo en el tratamiento de la enfermedad microscópica residual intraperitoneal. La indicación de este método se ha ido extendiendo de forma progresiva, para pacientes con CP muy bien seleccionados; y tiene base en varios estudios de fase III, cuya conclusión es que se puede obtener suficiente citoreducción. Sin embargo, hasta el momento existe cierto consenso basado en la evidencia, en que estaría indicada en pacientes portadores de pseudomixoma peritoneal, mesotelioma peritoneal y cáncer colorrectal; y en CP de otro origen, dependiendo de cada caso en particular.

The aim of this article is to provide a review of some current therapeutic strategies for patients with peritoneal carcinomatosis (PC), which historically has been considered a terminal condition, only amenable to palliative care, and occasionally systemic chemotherapy alone with poor response and lower average survival. The combination of cytoreductive surgery (CRS), which involves peritonectomy and multivisceral resections and intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) is a relatively new intraperitoneal treatment of microscopic residual disease concept. The indication of this method has been extended progressively to highly selected patients with PC and it is based in several phase III studies, which concluded that it is possible to obtain sufficient cytoreduction. However, until now there is some consensus based on evidence, in which HIPEC would be indicated in patients with peritoneal PC originated in pseudomyxoma, peritoneal mesothelioma and colorectal cancer; and CP from another source, depending on each particularcase.

The Effectiveness of Cytoreductive Surgery with Intraperitoneal Hyperthermic Chemotherapy(IPHC) for Far-Advanced Gastric Cancer

A prominent cause of death in patients with advanced gastric cancer is peritoneal metastasis or recurrence. There is no definite preventive surgery or treatment in such cases. Cancer tissue is more heat labile than normal tissue, and the administration of anticancer drugs interacts synergically with hyperthermia. The ability of anticancer drugs to eradicate the malignant cells is dependent not only on the dose of the antineoplastic drug but also on the number of tumor cells. Therefore, for success, the combination therapy of cytoreductive surgery and IPHC may be necessary in advanced gastric cancer. We performed this study to evaluate the toxicity and the clinical efficacy of IPHC in far-advanced gastric cancer and to assess the concentration of CDDP. Twenty one patients (11 females and 10 males) with gross serosal invasion (with or without peritoneal metastasis) underwent cytoreductive surgery and were treated with IPHC via hyperex-GHT-cpl (Green Cross Med. Corp. Korea) before closure of the abdominal wound. The IPHC was done using CDDP (200~400 mg/m2) and MMC (30~50 mg/m2) with 10 liters of normal saline as the perfusate. The peritoneal temperature during the IPHC was maintained at 42oC for 60 minutes. We used a modified peritoneal cavity expander to achieve free flow of the perfusate. The concentrations of the plasma and the perfusate were measured by atomic absorption spectrometry (Varian 300 A). Sixteen patients were stage IV, 3 were IIIb, and 2 were IIIa. The plasma concentraton of CDDP was 1.8 ug/ml at 10 minutes after perfusion and reached a maximal concentration (MXC) of 3.6 ug/ml. The area under the time-concentration curve (AUC) of the plasma at the 48th hour after perfusion was 3031.1 ug.min/ml. At the 24th hour, the maximum concentration of CDDP in the perfusate was 16.2 ug/ml. The AUC of the perfusate was 1703.3 ug min/ml at the 24th hour and 1817.7 ug min/ml at the 48th hour. The ratio of AUC of perfusate and the AUC of the plasma were 0.92 at the 24th hour and 0.59 at the 48th hour. The postoperative compllications were lymphatic leakage (2), pneumonia (1), and paralytic ileus (1). The most common drug-related complications of IPHC were anemia (WHO grade I), hematuria, leukopenia, jaundice, and thrombocytopenia in such order. These side effects were eliminated by conservative treatment within 4 weeks postoperatively. We could not determine the long term survival rate because of the short follow up period. However, the mean survival of the cases was about 12.0 months. The three deaths among the resected cases were due to extraperitoneal recurrences. The combination therapy of IPHC and cytoreductive is available for clinical use with a high AUC, high intraperitoneal CDDP concentration with a reasonable plasma concentration and has no threatening complications or mortality.