Current Situation of Hyperthermic Intraperitoneal Chemotherapy in Peritoneal Carcinoma / 肿瘤防治研究

Peritoneal carcinoma is a kind of malignant tumor which occurs and develops on the peritoneum, including primary and secondary tumors. Hyperthermic intraperitoneal chemotherapy is a combined therapy of intraperitoneal perfusion, hyperthermia and chemotherapy on peritoneal cancer, with satisfactory curative effect. In recent years, with the continuous progress of technology and research, hyperthermic intraperitoneal chemotherapy has become the most effective method for the treatment of peritoneal cancer. In this paper, we review the current situation of hyperthermic intraperitoneal chemotherapy on peritoneal cancer.

Strategies and challenges in the diagnosis and treatment of colorectal cancer peritoneal metastasis / 中华胃肠外科杂志

Peritoneum is a common metastatic site of colorectal cancer and has worse prognosis compared with other metastatic sites. Peritoneal metastasis was previously considered as a terminal state of the disease, and palliative treatment with systemic chemotherapy was the main treatment method. With the gradual acceptance of the cytoreductive surgery (CRS) + hyperthermic intraperitoneal chemotherapy (HIPEC) treatment model by surgeons and the application of targeted and immunotherapeutic drugs, the prognosis of patients with colorectal cancer peritoneal metastasis has been greatly improved. However, the diagnosis and treatment of peritoneal metastasis still face many challenges and controversies. Based on the evolution of the understanding of colorectal cancer peritoneal metastasis, the possible mechanisms of peritoneal metastasis are discussed, including the theory of "oligometastases" and the theory of "seed and soil". Besides, we further investigate the diagnosis and treatment strategies of colorectal cancer peritoneal metastasis and the facing challenges, including the limitations of imaging examination, the controversy of laparoscopic exploration, the difficulty in assessing peritoneal metastatic load, the limited means of postoperative recurrence monitoring and efficacy evaluation, and the significant variation in the diagnosis and treatment level among different regions of China. Meanwhile, we emphasize the importance of multidisciplinary perioperative management of CRS+HIPEC, and propose that the basic and clinical transformation research of peritoneal metastasis should be strengthened, and the promotion of standardized diagnosis and treatment of peritoneal metastasis is the key to improve the prognosis of patients with colorectal cancer peritoneal metastasis.

An unusual case of primary peritoneal adenocarcinoma

Primary peritoneal adenocarcinoma is sporadic with few cases cited in pre-existing literature. This cancer arises from the peritoneal epithelium lining of the abdomen, which is derived from extra ovarian mesothelium. It generally carries a poor prognosis. The treatment strategies are similar to ovarian serous papillary carcinoma. Report an incidental finding of primary peritoneal adenocarcinoma in a 39-year-old female army personnel, currently undergoing her chemotherapy and thriving. Exploratory laparotomy was done given the incidental finding of a mass on the contrast-enhanced computed tomography scan (CT). The mass was attached to the greater omentum, however, did not invade the mucosa of the transverse colon. Given this, part of greater omentum was removed. The findings of the immunohistochemical studies of the tumour are described within this report. The diagnosis of a primary peritoneal adenocarcinoma, stage II was established as no other primary site were found upon further investigation. The patient was treated with chemotherapy (carboplatin/paclitaxel) which was planned for 6 cycles. Otherwise, the patient had an uneventful postoperative course, is underway her chemotherapy regime and is planned for interim CT study to assess chemotherapy response. To conclude, isolated solitary primary peritoneal adenocarcinoma without peritoneal carcinomatosis, gastrointestinal manifestations and ascites are rare. This case, however, demonstrates the importance of its diagnosis, accurate evaluation and management.

Diagnostic Dilemma: A Case Report on Primary Peritoneal Carcinoma in a Patient with Suspected Ovarian Malignancy

@#INTRODUCTION: Primary peritoneal carcinoma (PPC) is an uncommon malignancy and is often misdiagnosed as peritoneal carcinomatosis from metastatic gastrointestinal carcinoma and more frequently from ovarian carcinomas due to a common embryonic origin of the ovary and the peritoneum. Its diagnosis is a challenge for clinicians. Herein, we report a rare case of PPC in a 72-year-old woman who was initially suspected with metastatic ovarian malignancy, and emphasizes points that help differentiate PPC from primary ovarian cancer. CASE: This a case of a 72-year-old female with abdominal discomfort and distension, initially diagnosed with ovarian carcinoma, with abdominal CT scan revealing thickening of the omentum multiple enhancing nodules in the left adnexa, within the pouch of Douglas and subdiaphragmatic region compatible with malignancy such as metastases from carcinoma. Cancer antigen (CA) 125 (3476 u/mL) and CA 15-3 (45.94 u/mL) were elevated. The patient underwent dilation and curettage and diagnostic laparoscopy and biopsy with frozen section, which revealed metastatic clear cell adenocarcinoma, favoring primary ovarian carcinoma. The patient then underwent exploratory laparotomy, total abdominal hysterectomy, bilateral salpingo-oophorectomy with bilateral lymph node dissection, and omentectomy. Further histopathological findings later confirmed that the patient had carcinoma primarily from the peritoneum instead of from the ovary. The patient was discharged, improved and underwent chemotherapy post-operation. CONCLUSION: This report emphasizes how to distinguish primary malignancy from the peritoneum from that in the ovary, preventing misdiagnosis. The emphasis in considering primary peritoneal cancer as a differential diagnosis in patients with abdominal symptoms suspected due to malignancy should be noted.

Primary Peritoneal Carcinoma with long term survival: A case report / Philippine Journal of Obstetrics and Gynecology

@#Primary peritoneal carcinoma is rare, presents with non-specific abdominal symptoms, is usually diagnosed late and is associated with a poor prognosis. A 51-year-old female with Primary Peritoneal Carcinoma Stage III-C, was initially treated with cytoreductive surgery and intravenous paclitaxel and carboplatin. After 28 months in remission, she developed tumor recurrence. She underwent tumor excision followed by combined intravenous paclitaxel and intraperitoneal carboplatin. The patient is alive and disease-free 5 years after the initial operation. This case was reported to inform our clinicians that the peritoneum can be the primary site of a rare malignancy. Prognosis may be poor but long-term survival can be achieved in younger patients with good performance status. Having a tumor that is sensitive to platinum-based chemotherapy can contribute to a longer survival even if the tumor was sub-optimally reduced.

Tuberculous Peritonitis Mimicking Primary Peritoneal Carcinoma

Tuberculous peritonitis is one of the most common extrapulmonary tuberculosis. The presenting signs and symptoms, together with the carbohydrate antigen (CA) 125 status and imaging findings may resemble the primary peritoneal carcinoma or ovarian carcinoma. We herein report a case on a 71-year-old woman who is presented with abdominal distension, abdominal pain, nausea, anorexia. Abdomino-pelvic computed tomography scans reveal large amounts of ascites and mottled omentum with diffuse nodular masses, and the serum CA 125 level is elevated. The initial clinical diagnosis is the primary peritoneal carcinoma, but the final histological diagnosis confirms the tuberculous peritonitis. Thus, we discuss the differential diagnosis of tuberculous peritonitis from primary peritoneal carcinoma and also the problems especially found in old aged patients. In conclusion, although the elderly patients are suspected with malignancy, we should keep in mind the possibility of curable diseases and perform laparoscopic biopsy during the early stage aggressively.

Mesotelioma maligno difuso primario de peritoneo / Primary diffuse malignant peritoneal mesothelioma

El mesotelioma peritoneal maligno es una neoplasia de presentación infrecuente, de curso insidioso, sintomática y de presentación poco específica en fase avanzada, de difícil diagnóstico y alta letalidad. Es la neoplasia más común de la serosa peritoneal, ocupando el segundo lugar de localización de los mesoteliomas, después del mesotelioma pleural. Es más frecuente en hombres, en mayores de 60 años y se ha relacionado en un 80% a la exposición crónica al asbesto. Generalmente su primera manifestación es ascitis, que se acompaña de dolor abdominal, astenia, hiporexia y pérdida de peso. Se puede diagnosticar a través del estudio histológico e inmunohistoquímico de líquido ascítico, biopsia peritoneal, y como métodos complementarios, TC de Abdomen y CT-PET. Presentamos el caso de un paciente masculino de 70 años de edad, con antecedente de adenocarcinoma prostático tratado con radioterapia y bloqueo hormonal, en remisión, Cardiopatía Isquémica e Hipertensiva en condición post-Bypass coronario, quien consulta por disnea, ascitis, hiporexia, astenia, con evidencia de líquido ascítico hemorrágico y GASA de bajo gradiente.

Malignant peritoneal mesothelioma is an infrequent neoplasm, of insidious course, symptomatic presentation and usually is diagnosed at an advanced stage diagnosis. It is the most common malignancy of the peritoneum and the the second location of mesothelioma, preceded by pleural mesothelioma. It is more common in men older than 60 year sand has been linked in 80% to chronic exposure to asbestos. Usually ascites, abdominal pain, fatigue, decreased appetite and weight loss are the first signs. It can be diagnosed through histological and immunohistochemical study of ascitic fluid, peritoneal biopsy, abdominal CT and CT-PET. We report the case of a male patient. 70 years with a history of heart disease and prostatic carcinoma treated with radiotherapy and immunosupressive therapy, who consults with dyspnea, ascites, hyporexia, fatigue and evidence of hemorrhagic ascites.

Clinicopathologic characteristics and prognostic factors of primary peritoneal carcinoma / 대한산부인과학회지

OBJECTIVE: The objective of this study was to examine the clinicopathologic characteristics and prognostic factors of primary peritoneal carcinoma (PPC). METHODS: Clinicopathologic variables were obtained by examining the medical records of patients with PPC who were diagnosed and treated at our institute, between January 1996 and December 2005. To find prognostic factors, the association of clinicopathologic variables with survival was evaluated by univariate and multivariate analysis. RESULTS: All patients had advanced-stage tumors. Residual tumor was smaller than 1 cm in 12 patients and was equal or larger than 1 cm in nine patients. The response rate to adjuvant chemotherapy was 47.6%. The median progression-free survival was eight months (range 1~95) and the median overall survival was 14 months (range 1~99). In univariate analysis, stage, the response to adjuvant chemotherapy, and neoadjuvant chemotherapy were associated with survival. However, in multivariate analysis, no variables were associated with survival. CONCLUSION: In spite of aggressive treatments, patients with PPC had poor prognosis. No prognostic factors were identified in this study.

Clinical Characteristics of Primary Peritoneal Carcinoma / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The goal of this study was to determine the clinical and therapeutic characteristics of women with a primary peritoneal carcinoma (PPC). MATERIALS AND METHODS: A retrospective clinical study was conducted to evaluate 22 women diagnosed with a PPC from 1993 to 2007 at the Hospitals of The Catholic University of Korea. Diagnoses were based on the Gynecologic Oncology Group criteria and clinical data. We collected patient clinicopathological data including age, presenting symptoms, pretreatment CA-125 values (U/ml), clinical stage (based on the FIGO stage), performance status (using the Eastern Cooperative Oncology Group scale), whether cytoreductive surgery was optimal or not, types of chemotherapy and response to treatment. We evaluated the clinical characteristics and response to treatment, time to treatment failure and overall survival. RESULTS: The median overall survival of all patients was 23.1 months. The estimated 3-year survival rate was 29% (SE, 13%). The response rate to first-line platinum-based chemotherapy was 79% and the median time to treatment failure was 9.9 months (95% confidence interval, 1.38~18.4 months). By univariate and multivariate analysis, performance status was the only significant factor associated with overall survival (p<0.05). CONCLUSION: We evaluated the clinical characteristics and treatment response of patients with a primary peritoneal carcinoma. Our results showed that it is possible to achieve long-term survival in patients with PPC. A further clinical study is to need to establish clinical characteristics and treatment outcomes.

Diagnosis and Treatment of Primary Peritoneal Carcinoma / 医学研究杂志

Objective To investigate the relationship between diagnosis and treatment of the primary peritoneal carcinoma(PPC)and its prognosis.Methods The clinical materials of 10 women,who were diagnosed with PPC,were analyzed retrospectively from Mar.2000 to Nov.2006.Results We found that PPC has lower rate of incidence,higher rate of wrong diagnosis,wider spread in pelvis cavity and abdominal cavity and had no significant clinical signs and symptoms specificity.All of the patients needed cytoreductive surgery,but the majority of rudimental focus diameter is larger than 2 cm.After the operation,platinum combined other chemotherapeutic drug were needed.Conclusion Abdominal distention,ascites,abdominal pain are the main symptoms and signs of PPC.we need choose cytoreductive surgery as much as possible.Extra trauma to patients will affect restoration and survival time of patients and the effect of chemotherapy.We also found the effect of abdominal cavity chemotherapy may be better than that of chemotherapy in vein.

The prognostic factors and survival analysis of primary peritoneal carcinoma / 대한산부인과학회지

OBJECTIVE: To date, few attempts have been made at clinical features and prognostic factors of primary peritoneal carcinoma (PPC) because of low prevalence. The aim of this study is to evaluate the clinical characteristcs and determine the prognosis factors of PPC. METHODS: From March 1996 to March 2004, a total of 23 women newly diagnosed with PPC were recruited into the study. Overall survival and prognostic factors were evaluated using Kaplan-Meier method and Cox regression model. RESULTS: The mean age of patients was 58.7+/-7.6 years and the FIGO stage was advanced disease; stage IIIc (73%) and IV (27%). The mean survival time for patients enrolled was 26.0 months. By univariate analysis, tumor state (p=0.028), performance status (p=0.045), the presence of initial debulking operation (p=0.035), and normalization of CA125 at 3 months of treatment (p=0.003) were significantly correlated with survival. On multivariate analysis, only the normalization of CA125 at 3 months of treatment remained as the independent factor for survival (Odds ratio, 6.896; 95% Confidence interval, 1.504-31.623; p=0.013). CONCLUSION: The mean survival time for patients with PPC was 26.0 months, and the normalization of CA125 at 3 months of treatment was identified as the independent prognostic factor. From this study, we analysis the clinical characteristics of PPC and provide more precise understanding of this disease.

A Case of Primary Peritoneal Carcinoma / 대한부인종양콜포스코피학회잡지

Primary papillary serous carcinomas (PPC) of the peritoneum are very rare and classically present with widespread intraperitoneal dissemination, superficial invasion, and minimal ovarian stromal involvement. Because of clinically and histologically similar to advanced stage epithelial ovarian carcinoma the treatment has been a similar fashion-cytoreductive surgery followed by systemic chemotherapy. Histologic differentiation between papillary mesotheliomas, primary ovarian tumors, borderline tumors of the ovary with peritoneal deposits and primary peritoneal carcinoma may be difficult. The prognosis is very poor and the median lifespan 4 months. We experienced a case of primary peritoneal carcinoma and reported with the brief review of the literature.

Two Cases of Primary Papillary Serous Peritoneal Carcinoma / 대한산부인과학회잡지

The well-documented but rare primary papillary serous peritoneal tumors are difficult problems for the pathologist and the clinician. The peritoneal serous papillary tumors were morphologically identical to serous ovarian tumor of equivalent grade. Because of their unusual location, these tumor are often classified as mesothelioma or advanced epithelial ovarian carcinoma. We experienced two cases of primary papillary serous peritoneal carcinoma and report with brief review of literature.

Two Cases of Primary Carcinoma of the Peritoneum / 대한부인종양콜포스코피학회잡지

The primary malignant tumor of the peritoneum also known as primary peritoneal carcinoma or primary peritoneal papillary serous carcinoma is rare and involves the peritoneum, especially the pelvic peritoneum of female patients. It is difficult to differentiate histologically between papillary mesothelioma, primary ovarian tumor and primary peritoneal carcinoma. We report two cases of the primary peritoneal carcinoma with clinical presentation and histologic characteristics.