Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) in peritoneal sarcomatosis—A systematic review and meta-analysis

Wong, Louis Choon Kit; Li, Zhenyue; Fan, Qiao; Tan, Joey Wee-Shan; Tan, Qiu Xuan; Wong, Jolene Si Min; Ong, Chin-Ann Johnny; Chia, Claramae Shulyn

doi:10.1016/j.ejso.2021.10.013

Cited by 19 publications

(10 citation statements)

References 41 publications

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“…At present, there is no clear evidence on the benefit of performing HIPEC after CRS for soft tissue sarcoma with peritoneal metastases. A meta-analysis of CRS with HIPEC in peritoneal sarcomatosis from a range of histologies including DSRCT reported a pooled median OS of 29.3 months for CRS with HIPEC, compared to a median OS of 13–18 months in patients treated with CRS, chemotherapy and radiotherapy [ 50 ]. The authors concluded that HIPEC may improve outcomes in some patients with peritoneal metastases from soft tissue sarcoma, but the level of evidence remains poor as the quality of the included studies was low [ 50 ].…”

Section: Hipecmentioning

confidence: 99%

“…A meta-analysis of CRS with HIPEC in peritoneal sarcomatosis from a range of histologies including DSRCT reported a pooled median OS of 29.3 months for CRS with HIPEC, compared to a median OS of 13–18 months in patients treated with CRS, chemotherapy and radiotherapy [ 50 ]. The authors concluded that HIPEC may improve outcomes in some patients with peritoneal metastases from soft tissue sarcoma, but the level of evidence remains poor as the quality of the included studies was low [ 50 ]. Specifically for DSRCT, a phase 2 trial comprising 20 patients undergoing CRS and oxaliplatin HIPEC at MDACC achieved a 3-year OS of 79% with a median OS of 58.4 months from diagnosis [ 28 ].…”

Section: Hipecmentioning

confidence: 99%

“…The rates of grade III–IV morbidity after CRS with HIPEC in all peritoneal surface malignancies range between 22 and 34% and 30-day mortality rates are 0.8–4.1% [ 51 ]. A meta-analysis specific for CRS with HIPEC in peritoneal metastases from soft tissue sarcoma found an incidence of 17.4% for complications requiring invasive intervention [ 50 ]. In addition, the intraperitoneal chemotherapy agent utilized may carry specific risks.…”

Section: Hipecmentioning

confidence: 99%

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Intra-Abdominal Desmoplastic Small Round Cell Tumor (DSRCT) and the Role of Hyperthermic Intraperitoneal Chemotherapy (HIPEC): A Review

et al. 2023

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Desmoplastic small round cell tumor is a very rare and highly aggressive soft tissue sarcoma, usually presenting with multiple intra-abdominal tumors in young males. Patients present with advanced disease and the overall survival is dismal. Multiple studies report relatively favorable outcomes with multimodal treatment consisting of chemotherapy, surgery and radiotherapy. If resection is feasible, complete cytoreductive surgery is the cornerstone of surgical treatment. The benefit of hyperthermic intraperitoneal chemotherapy in addition to cytoreductive surgery is unclear, and few studies have evaluated this option. We sought to identify the role of hyperthermic intraperitoneal chemotherapy in patients with intra-abdominal desmoplastic small round cell tumor. Our review of the available literature revealed no clear survival benefit in performing hyperthermic intraperitoneal chemotherapy after cytoreductive surgery.

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Section: Hipecmentioning

confidence: 99%

Section: Hipecmentioning

confidence: 99%

Section: Hipecmentioning

confidence: 99%

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Intra-Abdominal Desmoplastic Small Round Cell Tumor (DSRCT) and the Role of Hyperthermic Intraperitoneal Chemotherapy (HIPEC): A Review

et al. 2023

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“…While the role of CRS plus HIPEC in peritoneal carcinomatosis has been well-documented, its utility in peritoneal sarcomatosis remains unproven. The applications of CRS and HIPEC were analysed by a recent meta-analysis by Wong et al ( 26 ), in which 16 studies with 320 women were included. The mean PCI was 11.8 and 79.3% out of 256 subjects who achieved CC-0 cytoreduction.…”

Section: Peritoneal Sarcomatosismentioning

confidence: 99%

HIPEC for gynaecological malignancies: A last update (Review)

Margioula‐Siarkou

Almperis

Παπανικολάου

et al. 2023

Med Int

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Advanced-stage gynaecological cancer represents a clinical entity with challenging surgical treatment in an effort to optimize prognosis. Hyperthermic intraperitoneal chemotherapy (HIPEC) following cytoreductive surgery (CRS) has been reported as a method potentially eligible to improve prognosis. However, no definitive conclusions have yet been made on which types of cancer and which context HIPEC may actually have a beneficial impact. The present review discusses the efﬁcacy and safety of HIPEC as a treatment option for patients with primary/recurrent ovarian, endometrial and cervix cancer, as well as peritoneal sarcomatosis. A literature search was conducted using MeSH terms for each topic in the PubMed database and supplemented with a manual search to retrieve additional articles eligible for inclusion/fulfilling the inclusion criteria. The implementation of HIPEC appears to be beneficial in terms of survival in patients with epithelial ovarian carcinoma (EOC) following neoadjuvant chemotherapy, as well as in patients with recurrent EOC. Statistical superiority is not justified by current studies regarding other gynaecological malignancies with peritoneal dissemination. Furthermore, as regards safety, HIPEC following CRS does not appear to significantly increase the mortality and morbidity rates compared to the use of CRS alone. The rationale for using HIPEC and CRS in the treatment of ovarian cancer, particularly in the neoadjuvant setting, as well as for recurrences, is adequately evidenced, with acceptable safety and post-operative complication rate profiles. Its current place in the multimodal strategy for patients with peritoneal metastases remains uncertain, however. Randomized clinical trials are warranted to further examine the use of HIPEC and establish the optimal regimen and temperature settings. The role of optimal cytoreduction and no residual disease, as well as the proper patient selection remain basic parameters for maximizing survival parameters.

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“…Imaging evaluation is nearly the only way to detect PS preoperatviely, but its diagnostic sensitivity is unsatisfactory. Some studies showed that the prognosis of patients with PS remains dismal, with a median survival of approximately 1 year ( 12 , 13 ). Therefore, the management of PS is confronted with huge challenge and deserves more attention.…”

Section: Introductionmentioning

confidence: 99%

Multidimensional characteristics, prognostic role, and preoperative prediction of peritoneal sarcomatosis in retroperitoneal sarcoma

et al. 2022

Front. Oncol.

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BackgroundPeritoneal sarcomatosis (PS) could occur in patients with retroperitoneal sarcomas (RPS). This study aimed to expand the understanding of PS on its characteristics and prognostic role, and develop a nomogram to predict its occurrence preoperatively.MethodsData of 211 consecutive patients with RPS who underwent surgical treatment between 2011 and 2019 was retrospectively reviewed. First, the clinicopathological characteristics of PS were summarized and analyzed. Second, the disease-specific survival (DSS) and recurrence-free survival (RFS) of patients were analyzed to evaluate the prognostic role of PS. Third, preoperative imaging, nearly the only way to detect PS preoperatively, was combined with other screened risk factors to develop a nomogram. The performance of the nomogram was assessed.ResultsAmong the 211 patients, 49 (23.2%) patients had PS with an incidence of 13.0% in the primary patients and 35.4% in the recurrent patients. The highest incidence of PS occurred in dedifferentiated liposarcoma (25.3%) and undifferentiated pleomorphic sarcoma (25.0%). The diagnostic sensitivity of the preoperative imaging was 71.4% and its specificity was 92.6%. The maximum standardized uptake value (SUVmax) was elevated in patients with PS (P<0.001). IHC staining for liposarcoma revealed that the expression of VEGFR-2 was significantly higher in the PS group than that in the non-PS group (P = 0.008). Survival analysis (n =196) showed significantly worse DSS in the PS group than in non-PS group (median: 16.0 months vs. not reached, P < 0.001). In addition, PS was proven as one of the most significant prognostic predictors of both DSS and RFS by random survival forest algorithm. A nomogram to predict PS status was developed based on preoperative imaging combined with four risk factors including the presentation status (primary vs. recurrent), ascites, SUVmax, and tumor size. The nomogram significantly improved the diagnostic sensitivity compared to preoperative imaging alone (44/49, 89.8% vs. 35/49, 71.4%). The C-statistics of the nomogram was 0.932, and similar C-statistics (0.886) was achieved at internal cross-validation.ConclusionPS is a significant prognostic indicator for RPS, and it occurs more often in recurrent RPS and in RPS with higher malignant tendency. The proposed nomogram is effective to predict PS preoperatively.

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Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) in peritoneal sarcomatosis—A systematic review and meta-analysis

Cited by 19 publications

References 41 publications

Intra-Abdominal Desmoplastic Small Round Cell Tumor (DSRCT) and the Role of Hyperthermic Intraperitoneal Chemotherapy (HIPEC): A Review

Intra-Abdominal Desmoplastic Small Round Cell Tumor (DSRCT) and the Role of Hyperthermic Intraperitoneal Chemotherapy (HIPEC): A Review

HIPEC for gynaecological malignancies: A last update (Review)

Multidimensional characteristics, prognostic role, and preoperative prediction of peritoneal sarcomatosis in retroperitoneal sarcoma

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