Cytoreductive Surgery plus Hyperthermic Intraperitoneal Chemotherapy for Management of Peritoneal Sarcomatosis: A Preliminary Single-Center Experience from Saudi Arabia

Abstract

Aim. To report our preliminary single-center experience with cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) for management of peritoneal sarcomatosis (PS). Methods. Eleven patients were retrospectively analyzed for perioperative details. Results. Cytoreduction completeness (CC-0/1) was achieved in all patients with median peritoneal cancer index (PCI) of 14 ± 8.9 (range: 3–29). Combination cisplatin + doxorubicin HIPEC chemotherapy was used in 6 patients. Five patients received intraoperative radiation therapy (IORT). The median operative time, estimated blood loss, and hospital stay were 8 ± 1.4 hours (range: 6–10), 1000 ± 250 mL (range: 700–3850), and 11 ± 2.4 days (range: 7–15), respectively. Major postoperative Clavien-Dindo grade III/IV complications occurred in 1 patient and none developed HIPEC chemotherapy-related toxicities. The median overall survival (OS) and disease-free survival (DFS) after CRS + HIPEC were 28.3 ± 3.2 and 18.0 ± 4.0 months, respectively. The median follow-up time was 12 months (range: 6–33). Univariate analysis of several prognostic factors (age, gender, PS presentation/pathology, CC, PCI, HIPEC chemotherapy, and IORT) did not demonstrate statistically significant differences of OS and DFS. Conclusion. CRS + HIPEC appear to be feasible, safe, and offer survival oncological benefits. However, definitive conclusions cannot be deduced.

A Simplified Peritoneal Sarcomatosis Score for patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

“…Currently, the only approach that provided an improved survival for PS is CRS/HIPEC when CC0 is achieved (6,16,17). In the past decade, multiple institutional experiences were reported (16)(17)(18)(19)(20)(21)(22) about the impact of CRS/HIPEC on survival in PS and agreed on OS of 24−28 months and DFS of 14−18 months. We have reported that a complete cytoreduction and low PCI score appear to be important factors in the outcome of patient with PS (6).…”

Dedifferentiated liposarcoma with a rare presentation of disseminated intraperitoneal sarcomatosis: A case report

“…To date, there have been 4 retrospective single-institution series and 1 phase I study examining the role of cytoreductive surgery (CRS) and intra-peritoneal chemotherapy in the treatment of peritoneal sarcomatosis [[42], [43], [44], [45], [46]]. However, mixed outcomes have been reported and there is marked heterogeneity in histological types, and inclusion and exclusion criteria across the studies.…”

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in seven patients with peritoneal sarcomatosis from uterine sarcoma

“…Uterine sarcoma is a rare and aggressive disease, representing 3–9% of uterine cancers . This malignancy has poor prognosis due to its biological behavior, high rates of recurrence, and ineffective treatment with the current therapeutic modalities . Progression to PS frequently occurs after initial treatment ; however, PS may be present at the first presentation of US .…”

“…It results from the intra‐abdominal spread of malignant disease involving the peritoneal surface. PS is characterized by an increased risk of recurrence and poor long‐term survival (median overall survival 6–15 months), indicating lack of an effective treatment . Classic therapeutic modalities such as radiotherapy, chemotherapy, and palliative surgery have not been shown to improve patient outcomes .…”