Treatment of peritoneal carcinomatosis from ovarian cancer. Present, future directions and proposals

Abstract

Peritoneal carcinomatosis, considered years ago as a final stage of unresectable cancer, can now be managed with curative intention by means of a radical cytoreductive surgical procedure with associated peritonectomy and intraperitoneal chemotherapy, as described by Sugarbaker. Malignant neoplasms such as mesothelioma and pseudomyxoma peritonei, ovarian and colon cancer nowadays are experiencing some new therapeutical approaches. Higher survival rates can be reached in ovarian cancer, which is commonly diagnosed in the presence of peritoneal carcinomatosis, using an optimal cytoreductive radical surgery with intraperitoneal chemotherapy. An actualised review of the treatment of advanced ovarian cancer and a proposal of a national multicentre protocol for the treatment of peritoneal carcinomatosis from ovarian cancer has been performed by a group of Spanish surgeons and oncologists dedicated to a therapeutical approach to this pathology.

The role of hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) in the treatment of peritoneal carcinomatosis in recurrent ovarian cancer

“…Peritoneal cancer index average (mean PCI) was of 13±6 in both groups with a range of 6-24 in the HIPEC group and 7-21 in the non-HIPEC group. As regards to the postoperative mean time at the hospital, the average was about 14±4 days (range [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] in the HIPEC group opposed to 10±4 days (range [6][7][8][9][10][11][12][13][14][15][16][17][18][19] in the non-HIPEC group.…”

“…On the other hand, since 2004, we have associated HIPEC to radical cytoreductive surgery with peritonectomy in all patients with ovarian peritoneal carcinomatosis based on the positive results obtained by us and other groups [13][14][15]. From this data, HIPEC has always been applied during this surgical procedure, and this approach has been recently proposed for a multicentre protocol involving different national centres in the Grupo Español de Cirugía Oncológica Peritoneal (GECOP) [18]. Fig.…”

Pseudomyxoma peritonei treated by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: results from a single centre

“…All patients in the study had undergone surgery at least once at our institution over the course of the disease. The principles of cytoreductive surgery and HIPEC as performed at this centre and by this team have been reported previously [21]. Briefl y, cytoreductive surgery consists in resecting all visible tumour deposits using the following procedures: left parietal and subdiaphragmatic peritonectomy, right parietal and subdiaphragmatic peritonectomy with or without resection of Glisson's capsule, greater omentectomy with or without splenectomy, lesser omentectomy with or without cholecystectomy, pelvic peritonectomy with or without rectosigmoidectomy, hysterectomy with bilateral salpingooophorectomy, implant resection in hepatic and retrohepatic hilum, and lymphadenectomy in case of lymph node involvement.…”

“…CC-0: no macroscopic residual disease; CC-1: residual nodules of up to 2.5 mm in some regions; CC-2: residual nodules >2.5 mm and <2.5 cm; CC-3: residual nodules >2.5 cm. CC-0 and CC-1 were deemed optimal resection [21].…”

Neoadjuvant intraperitoneal chemotherapy with paclitaxel for the radical surgical treatment of peritoneal carcinomatosis in ovarian cancer: a prospective pilot study

“…Cytoreductive surgery degree was based on the classification described by the Gynecologic Oncologic Group (GOG) [10].…”