González-Moreno Advances in Peritoneal Surface Oncology

1. Auflage 2010
ISBN: 978-3-540-30760-0
Verlag: Springer
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, Band 169, 176 Seiten, eBook

Reihe: Recent Results in Cancer Research

S. González-Moreno (Ed. ) Advances in Peritoneal Surface Oncology With 45 Figures in 57 Separate Illustrations, 12 in Color and 19 Tables 123 IV Preface Santiago González-Moreno, MD, PhD Department of Surgical Oncology Centro Oncológico MD Anderson International España Calle Gómez Hemans 2 28033 Madrid Spain sgonzalez@mdanderson. es Library of Congress Control Number: 2006937141 ISSN 0080-0015 ISBN 978-3-540-30759-4 Springer Berlin Heidelberg New York This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, speci? ?cally the rights of translation, reprinting, reuse of illustrations, recitations, broadcasting, reproduction on micro? ?lm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer-Verlag. Violations are liable for prosecution under the German Copyright Law. Springer is part of Springer Science+Business Media http//www. springer. com Springer-Verlag Berlin Heidelberg 2007 Printed in Germany The use of general descriptive names, trademarks, etc. in this publication does not imply, even in the absence of a speci? ?c sta- ment, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product liability: The publishers cannot guarantee the accuracy of any information about dosage and application contained in this book. In every case the user must check such information by consulting the relevant literature.

Zielgruppe

Professional/practitioner

Autoren/Hrsg.

González-Moreno, S.

Inhaltsverzeichnis

Management of Peritoneal Surface Malignancy: A Short History.- The Natural History of Free Cancer Cells in the Peritoneal Cavity.- Pathological Evaluation and Implications of Serosal Involvement in Gastrointestinal Cancer.- Principles of Perioperative Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis.- Experimental and Pharmacokinetic Studies in Intraperitoneal Chemotherapy: From Laboratory Bench to Bedside.- Technology for the Delivery of Hyperthermic Intraoperative Intraperitoneal Chemotherapy: A Survey of Techniques.- Adjuvant Intraperitoneal Chemotherapy: A Review.- Clinical Research Methodology in Peritoneal Surface Oncology: A Difficult Challenge.- Lessons Learnt from Clinical Trials in Peritoneal Surface Oncology: Colorectal Carcinomatosis.- Experimental Models and Questions in Basic Science Research for Pseudomyxoma Peritonei.- Peritoneal Carcinomatosis of Colorectal Origin: Recent Advances and Future Evolution Toward a Curative Treatment.- Pathologic Characterization and Differential Diagnosis of Malignant Peritoneal Mesothelioma.- Advances in Clinical Research and Management of Diffuse Peritoneal Mesothelioma.- Advances in the Management of Gastric Cancer with Peritoneal Dissemination.- Intraperitoneal Chemotherapy in the Management of Ovarian Cancer.

Leseproben

"9 Lessons Learnt from Clinical Trials in Peritoneal Surface Oncology: Colorectal Carcinomatosis (p. 99-100)

Frans A. N. Zoetmulder and Vic J. Verwaal

9.1 Introduction

Very few surgical cancer therapies have been tested in randomised studies. An obvious reason for this is the fact that most cancer operations were developed in the age when randomised studies were simply not heard of. By now many cancer operations have proved to be curative in a considerable percentage of patients, and neither patients nor surgeons would want to miss that chance of permanent cure. After Sugarbaker had shown in a small randomised study that post-operative intraperitoneal 5-fluorouracil (5-FU) installations could prevent the development of peritoneal metastases in some high risk colon cancer patients [1] he developed this technique as treatment for patients with established peritoneal carcinomatosis (PC).

As he could show some promising results, a group of enthusiasts grew who invested heavily in this new approach towards an, until then, incurable disease. The post-operative 5-FU installation technique evolved into the hyperthermic intraperitoneal chemotherapy (HIPEC) technique with either mitomycin C or oxaliplatin, which is at present used in many centres. Notwithstanding promising results in phase II type studies from several centres [2– 13], it proved impossible to convince the wider medical oncology community of the benefits of cytoreduction and HIPEC in these patients. Gradually it became clear that only convincing evidence from a randomised study could achieve this goal.

9.2 Randomised Study in PC of Colorectal Origin

There is only one randomised study comparing the HIPEC approach with conventional treatment of PC of colorectal origin [14]. In this study from the Netherlands Cancer Institute patients with proven PC were randomised either to undergo limited palliative surgery followed by systemic treatment with 5-FU/leucovorin or to undergo cytoreduction and HIPEC, followed by the same systemic chemotherapy. One hundred and five patients were randomised in a 3-year period, 51 in the standard arm and 54 in the experimental arm.

Only 44 patients in the standard arm started their chemotherapy. Two patients refused the result of the randomisation and went abroad to undergo HIPEC treatment. The other patients did not start, mainly because of early progression. In the experimental arm five patients did not get their HIPEC therapy. One patient died while on the waiting list, one patient refused at the last minute, and three patients developed distant metastases in the time between randomisation and the planned operation date. HIPEC consisted of continuous peritoneal lavage with a solution containing mitomycin C at a dose of 35 mg/m2, with a maximum of 70 mg.

Half of this dose was administered at the start of the lavage, 25% after 30 min and 25% after 60 min, with a total lavage time of 90 min. The temperature was kept between 40°C and 42°C, at three measuring points in the abdomen. Thirty-five patients started their systemic chemotherapy after recovery from the HIPEC treatment. The main reason for not starting was a complicated post-operative period. Detailed information on the extent of PC was only available for the patients undergoing HIPEC.

Many patients had very extensive PC, with 54% having five or more of seven abdominal regions involved and over 30% having six or seven regions involved. It was possible to resect all macroscopic PC in 38% of patients. In 43% small residues (<2.5 mm) were left behind, whereas in 19% larger residues remained. To achieve this level of cytoreduction a multitude of surgical resections had to be done, including omentectomy and multiple bowel resections in most patients. In accordance with this extensive surgery complications have been frequent. Most common complications were infectious, related to small bowel leakage."