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Bansal VV, Belmont E, Godley F, Dhiman A, Witmer HD, Li S, Liao A, Eng OS, Turaga KK, Shergill A. Utility of Circulating Tumor DNA Assessment in Characterizing Recurrence Sites after Optimal Resection for Metastatic Colorectal Cancer. J Am Coll Surg 2024; 238:1013-1020. [PMID: 38299640 DOI: 10.1097/xcs.0000000000001028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
BACKGROUND Plasma circulating tumor DNA (ctDNA) is a promising biomarker for metastatic colorectal cancer (mCRC); however, its role in characterizing recurrence sites after mCRC resection remains poorly understood. This single-institution study investigated the timing of ctDNA detection and its levels in the context of recurrence at different sites after mCRC resection. STUDY DESIGN Patients who underwent optimal resection of CRC metastases involving the peritoneum, distant lymph nodes, or liver, with serial postoperative tumor-informed ctDNA assessments (Signatera) were included. Recurrence sites, as defined by surveillance imaging or laparoscopy, were categorized as peritoneal-only and other distant sites (liver, lung, lymph nodes, or body wall). RESULTS Among the 31 included patients, ctDNA was detected in all 26 (83.4%) patients with postoperative recurrence and was persistently undetectable in 5 patients who did not experience recurrence. At 3 months postsurgery, ctDNA was detected in 2 (25%) of 8 patients with peritoneal-only recurrence and 17 (94.4%) of 18 patients with distant recurrence (p < 0.001). Beyond 3 months, ctDNA was detected in the remaining 6 patients with peritoneal-only disease and 1 patient with distant disease. ctDNA detection preceded the clinical diagnosis of recurrence by a median of 9 weeks in both groups. At recurrence, peritoneal-only recurrent cases exhibited lower ctDNA levels (median 0.4 mean tumor molecules/mL, interquartile range 0.1 to 0.8) compared with distant recurrence (median 5.5 mean tumor molecules/mL, interquartile range 0.8 to 33.3, p = 0.004). CONCLUSIONS Peritoneal-only recurrence was associated with delayed ctDNA detection and low levels of ctDNA after optimal resection for mCRC. ctDNA testing may effectively characterize recurrence sites and may help guide subsequent treatments specific to the disease sites involved.
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Affiliation(s)
- Varun V Bansal
- From the Division of Surgical Oncology, Yale School of Medicine, New Haven, CT (Bansal, Turaga)
| | - Erika Belmont
- Department of Medicine, Section of Hematology/Oncology (Belmont, Liao, Shergill), University of Chicago Medical Center, Chicago, IL
| | - Frederick Godley
- Division of General Surgery and Surgical Oncology, Department of Surgery (Godley IV, Witmer, Li), University of Chicago Medical Center, Chicago, IL
| | - Ankit Dhiman
- Department of Surgery, Medical College of Georgia, Augusta, GA (Dhiman)
| | - Hunter D Witmer
- Division of General Surgery and Surgical Oncology, Department of Surgery (Godley IV, Witmer, Li), University of Chicago Medical Center, Chicago, IL
| | - Shen Li
- Division of General Surgery and Surgical Oncology, Department of Surgery (Godley IV, Witmer, Li), University of Chicago Medical Center, Chicago, IL
| | - Andy Liao
- Department of Medicine, Section of Hematology/Oncology (Belmont, Liao, Shergill), University of Chicago Medical Center, Chicago, IL
| | - Oliver S Eng
- Department of Surgery, Division of Surgical Oncology, University of California Irvine, Orange, CA (Eng)
| | - Kiran K Turaga
- From the Division of Surgical Oncology, Yale School of Medicine, New Haven, CT (Bansal, Turaga)
| | - Ardaman Shergill
- Department of Medicine, Section of Hematology/Oncology (Belmont, Liao, Shergill), University of Chicago Medical Center, Chicago, IL
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Valenzuela CD, Solsky IB, Erali RA, Forsythe SD, Mangieri CW, Mainali BB, Russell G, Perry KC, Votanopoulos KI, Shen P, Levine EA. Long-Term Survival in Patients Treated with Cytoreduction and Heated Intraperitoneal Chemotherapy for Peritoneal Mesothelioma at a Single High-Volume Center. Ann Surg Oncol 2023; 30:2666-2675. [PMID: 36754945 DOI: 10.1245/s10434-022-13061-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 12/26/2022] [Indexed: 02/10/2023]
Abstract
BACKGROUND Malignant peritoneal mesothelioma (MPM) is a rare diagnosis with a dismal prognosis if untreated. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is shown to significantly improve survival. Our institution is uniquely positioned to report long-term outcomes in MPM with CRS-HIPEC, due to our robust peritoneal surface disease program existing over the past three decades. METHODS Our prospectively maintained, single-institution database of CRS-HIPEC cases was reviewed, identifying 111 consecutive patients with MPM over 28 years (1993-2021). Prognostic, operative, and pathologic factors were reviewed. Overall survival (OS) and conditional survival (CS) analyses were performed. RESULTS The average age was 55.1 years; 58.6% of patients were male; 17 of 111 patients (15.3%) had a second CRS-HIPEC. At first CRS-HIPEC, the average PCI score was 18.7, and the perfusate drugs were platinum-based (72.1%) and mitomycin C (27.9%). The resection status at first CRS-HIPEC was R2a (46.4%), followed by R0-1 (29.1%), and R2b-c (24.5%). Median OS was 3.3 years for the entire cohort, with 75th and 25th percentiles at 10.7 months and 10.6 years. Median CS was improved if patients survived to the 1-year postoperative mark (4.9 years, p < 0.01) and trended toward further improvement with each passing year. If 3-year postoperative survival was achieved, the median CS improved to 6.1 years. CONCLUSIONS This represents one of the largest and lengthiest, single-center, longitudinal, case series of peritoneal mesothelioma treated with CRS-HIPEC. The OS suggests efficacy for CRS-HIPEC for MPM. Long-term survival improves significantly after patients achieve the 1-year, postoperative mark.
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Affiliation(s)
- Cristian D Valenzuela
- Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Ian B Solsky
- Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Richard A Erali
- Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Steven D Forsythe
- Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Christopher W Mangieri
- Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Bigyan B Mainali
- Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Gregory Russell
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Kathleen C Perry
- Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | | | - Perry Shen
- Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Edward A Levine
- Surgical Oncology, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA.
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Leebmann H, Piso P. [Current treatment recommendations for pseudomyxoma peritonei]. CHIRURGIE (HEIDELBERG, GERMANY) 2022; 93:1152-1157. [PMID: 36097078 DOI: 10.1007/s00104-022-01696-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The term pseudomyxoma peritonei (PMP) describes a clinical syndrome characterized by the presence of gelatinous intraperitoneal accumulation of mucus. It mostly originates from a mucocele of the vermiform appendix. Affected patients are often asymptomatic for a long time. Because of its indolent nature it is usually diagnosed at an advanced stage. Clinical presentation is determined by the dissemination of the tumor. METHOD A search and analysis of the current literature were carried out. RESULTS Based on the morphological characteristics PMP subtypes with various malignant potential can be differentiated. The prognosis depends on the histopathological differentiation and the clinical stage. The treatment spectrum varies from laparoscopic appendectomy to complete cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC). CONCLUSION Due to the rarity of PMP there are no prospective randomized studies. Therefore, there is still controversy regarding the best stage-dependent treatment strategy. This review article attempts to clarify the optimal management of mucinous neoplasms of the appendix and PMP taking the clinical presentation and the histological differentiation into consideration.
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Affiliation(s)
- H Leebmann
- Krankenhaus Barmherzige Brüder Regensburg, Prüfeninger Str. 86, 93049, Regensburg, Deutschland.
| | - P Piso
- Krankenhaus Barmherzige Brüder Regensburg, Prüfeninger Str. 86, 93049, Regensburg, Deutschland
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Mangieri CW, Levine EA. Management of peritoneal surface metastases from colorectal cancer: Cytoreductive surgery, hyperthermic intraperitoneal chemotherapy, pressurized intraperitoneal chemotherapy, and beyond. Front Oncol 2022; 12:992030. [PMID: 36425565 PMCID: PMC9679779 DOI: 10.3389/fonc.2022.992030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/23/2022] [Indexed: 08/30/2023] Open
Abstract
This article provides a contemporary review of the current surgical management of peritoneal surface malignancy (PSM) of colorectal origin. A brief review of the founding history of surgical intervention for PSM is followed by a focused review of the level I evidence, current clinical questions, and evolving advancements. While not intended to address all the facets of PSM, this review aims to provide the reader with the essential knowledge and resources to effectively provide surgical care for carcinomatosis due to colorectal malignancies.
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Affiliation(s)
| | - Edward A. Levine
- Division of Surgical Oncology, Wake Forest Baptist Health Medical Center, Winston-Salem, NC, United States
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Valenzuela CD, Levine EA, Votanopoulos KI, Shen P. ASO Author Reflections: Thirty Years of Repeat Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) at Wake Forest University. Ann Surg Oncol 2022; 29:3446-3447. [PMID: 35275327 DOI: 10.1245/s10434-022-11514-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Cristian D Valenzuela
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Edward A Levine
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Konstantinos I Votanopoulos
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Perry Shen
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
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Valenzuela CD, Votanopoulos KI, Levine EA, Shen P. ASO Author Reflections: When is the Best Time to Perform Repeat Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for a Recurrent Low-Grade Appendiceal Mucinous Neoplasm? Ann Surg Oncol 2022; 29:3432-3433. [PMID: 35257253 DOI: 10.1245/s10434-022-11515-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Cristian D Valenzuela
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Konstantinos I Votanopoulos
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Edward A Levine
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Perry Shen
- Department of Surgical Oncology, Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
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