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Psilopatis I, Damaskos C, Garmpis N, Vrettou K, Garmpi A, Sarantis P, Koustas E, Antoniou EA, Kouraklis G, Chionis A, Kontzoglou K, Dimitroulis D. The Role of Hyperthermic Intraperitoneal Chemotherapy in Uterine Cancer Therapy. Int J Mol Sci 2023; 24:12353. [PMID: 37569726 PMCID: PMC10419250 DOI: 10.3390/ijms241512353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 07/28/2023] [Accepted: 07/30/2023] [Indexed: 08/13/2023] Open
Abstract
Endometrial cancer and uterine sarcoma represent the two major types of uterine cancer. In advanced stages, both cancer entities are challenging to treat and correlate with a meagre survival and prognosis. Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is a form of localized chemotherapy that is heated to improve the chemotherapeutic effect on peritoneal metastases. The aim of the current review is to study the role of HIPEC in the treatment of uterine cancer. A literature review was conducted using the MEDLINE and LIVIVO databases with a view to identifying relevant studies. By employing the search terms "hyperthermic intraperitoneal chemotherapy", "uterine cancer", "endometrial cancer", and/or "uterine sarcoma", we managed to identify 26 studies published between 2004 and 2023. The present work embodies the most up-to-date, comprehensive review of the literature centering on the particular role of HIPEC as treatment modality for peritoneally metastasized uterine cancer. Patients treated with cytoreductive surgery, alongside HIPEC, seem to profit from not only higher survival but also lower recurrence rates. Factors such as the completeness of cytoreductive surgery, the peritoneal cancer index, the histologic subtype, or the applied chemotherapeutic agent, all influence HIPEC therapy effectiveness. In summary, HIPEC seems to represent a promising treatment alternative for aggressive uterine cancer.
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Affiliation(s)
- Iason Psilopatis
- Department of Obstetrics and Gynecology, University Erlangen, Universitaetsstrasse 21–23, 91054 Erlangen, Germany
| | - Christos Damaskos
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Nikolaos Christeas Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Renal Transplantation Unit, Laiko General Hospital, 11527 Athens, Greece
| | - Nikolaos Garmpis
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Nikolaos Christeas Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Kleio Vrettou
- Department of Cytopathology, Sismanogleio General Hospital, 15126 Athens, Greece
| | - Anna Garmpi
- First Department of Propedeutic Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Panagiotis Sarantis
- Molecular Oncology Unit, Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Evangelos Koustas
- Molecular Oncology Unit, Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Efstathios A. Antoniou
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Nikolaos Christeas Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Gregory Kouraklis
- Department of Surgery, Evgenideio Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Athanasios Chionis
- Second Department of Gynecology, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Konstantinos Kontzoglou
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Nikolaos Christeas Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Dimitrios Dimitroulis
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Nikolaos Christeas Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
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Düzgün Ö, Kalin M. Is There a Role for Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in Peritoneal Carcinomatosis Due to Uterine Cancer? J Pers Med 2022; 12:jpm12111790. [PMID: 36579503 PMCID: PMC9693328 DOI: 10.3390/jpm12111790] [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: 09/17/2022] [Revised: 10/17/2022] [Accepted: 10/26/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Uterine canceris one of the most common pelvic tumors in females. Advanced stage uterine cancer only represents 15% of newly diagnosed cases; however, they are related with poor prognosis. Our aim was to analyze the benefits of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in peritoneal carcinomatosis due to uterine cancer. METHODS At the Istanbul Umraniye Training and Research Hospital, Surgical Oncology Clinic, morbidity, overall survival and survival without progression were analyzed over the 5-year follow up. Twenty-two cases who had undergone cytoreductive surgery and hyperthermic intraperitoneal chemotherapy due to uterine-peritoneal carcinomatosis were included in this study. Cases were followed up in terms of postoperative morbidity-mortality, disease-free survival and overall survival. The cut off value for the peritoneal carcinomatosis index score was set at 15. Intraperitoneal chemotherapy consisting of cisplatin and doxorubicin was applied to all patients for 60 min after the suturation of the abdomen. RESULTS Median age of the patients was 64.6 (43-72). Average PCI score was 12.8 (3-15). CC score was 0 in 16 (72.7%) cases, 1 in 3 cases and 2 in 3 cases. Of these patients, 12 of them were previously operated upon. Median stay at the hospital was 13.1 days. No major complications due to chemotherapy were reported. A Clavien-Dindo Grade 3 complication was observed in seven (31.8%) patients. Mortality was not observed in patients during their stay at the hospital. The 5-year disease-free survival and overall survival rates were 36.8 (36%) months and 45.3 (57%) months, respectively. CONCLUSIONS We think that due to longer disease-free survival and overall survival, cytoreductive surgery and hyperthermic intraperitoneal chemotherapy should be preferred in peritoneal carcinomatosis due to uterine cancer patients having low peritoneal carcinomatosis index scores and manageable complication rates. However, prospective randomizedtrials with a high number of cases are needed for this subject.
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Xu X, Lu F, Fang C, Liu S. Construction of an Immune-Autophagy Prognostic Model Based on ssGSEA Immune Scoring Algorithm Analysis and Prognostic Value Exploration of the Immune-Autophagy Gene in Endometrial Carcinoma (EC) Based on Bioinformatics. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:7832618. [PMID: 35242299 PMCID: PMC8888084 DOI: 10.1155/2022/7832618] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/07/2022] [Accepted: 01/15/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Endometrial carcinoma (EC) is a malignant cancer spreading worldwide and in the fourth position among all other types of cancer in women. The purpose of this paper is to explore the prognostic value of the immune-autophagy gene in endometrial carcinoma (EC) based on bioinformatics, construct an immune-autophagy prognostic model of endometrial carcinoma, search for independent prognostic markers, and finally predict the potential therapeutic drugs of TCGA subgroup. METHODS The Cancer Genome Atlas (TCGA) database was used to extract transcriptome sequencing data of patients suffering from EC; 28 kinds of immune cells were scored by ssGSEA, and the immune subtypes were grouped by consistency cluster analysis. The accuracy and effectiveness of the grouping were verified by the analysis of differential gene expression and survival rate of immune checkpoints in the two groups to provide the premise and basis for the establishment of independent prognostic factors. The expression of different genes in high and low immune groups was analyzed. The analysis of various genes' expression in immune groups (high and low) has been performed. Go function annotation and KEGG pathway enrichment analysis were used to evaluate the difference of immune infiltration between high and low immune groups. The immune and autophagy genes were crossed, the key (hub) genes were selected, the risk was scored, the prognosis model was constructed, and the independent prognostic markers were established. CAMP and CTRP 2.0 were used to test the drug sensitivity. RESULTS According to the level of immune cell enrichment, the results have been subcategorized into two immune subtypes: high immunity group_ H and low immunity group_ L. Two immune subtypes, CD274, PDCD1, and CTLA4, were detected in the immune system_ H and immunity_L. A significant difference was detected between these two groups in the expression and survival rate. Few more differences were also detected between the two groups through the evaluation of immune infiltration, which proved the grouping's accuracy and effectiveness. Differential gene expression analysis showed that there were 721 DEGs and 3 hub genes. DEGs are mainly involved in lymphocyte activation, proliferation, differentiation, leukocyte proliferation, and other biological processes, mediate chemokines' activities, chemokine receptor binding, and other molecular functions, and are enriched in the outer plasma membrane, endoplasmic reticulum, and T cell receptor complex. The enriched pathways are allograft, complex, inflammatory, interferon-alpha, interferon-gamma, E2F, G2M, mitotic, etc. CONCLUSION Through bioinformatics analysis, we successfully constructed the immuno-autophagy prognosis model of endometrial cancer and identified three high-risk immunoautophagy genes, including VEGFA, CCL2, and Ifng. Four potential therapeutic drugs were predicted as sildenafil, sunitinib, TPCA-1, and etoposide.
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Affiliation(s)
- Xiaomin Xu
- Heilongjiang University of Chinese Medicine, Harbin, China
| | - Fang Lu
- School of Continuing Education, Heilongjiang University of Traditional Chinese Medicine, Harbin, China
| | - Cheng Fang
- Drug Safety Evaluation Center of Heilongjiang University of Traditional Chinese Medicine, Harbin, China
| | - Shumin Liu
- Heilongjiang University of Chinese Medicine, Harbin, China
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Gomes David M, Bakrin N, Salleron J, Kaminsky MC, Bereder JM, Tuech JJ, Lehmann K, Mehta S, Glehen O, Marchal F. Cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) vs CRS alone for treatment of endometrial cancer with peritoneal metastases: a multi-institutional study from PSOGI and BIG RENAPE groups. BMC Surg 2022; 22:1. [PMID: 34996419 PMCID: PMC8742414 DOI: 10.1186/s12893-021-01449-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 12/20/2021] [Indexed: 01/22/2023] Open
Abstract
Objective To investigate the benefit of cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) for the treatment of endometrial peritoneal carcinomatosis compared to CRS alone. Methods We conducted a retrospective multicentre study of patients from experienced centres in treating peritoneal malignancies from 2002 to 2015. Patients who underwent surgery for peritoneal evolution of endometrial cancer (EC) were included. Two groups of 30 women were matched and compared: “CRS + HIPEC” which used HIPEC after CRS, and “CRS only” which did not use HIPEC. We analysed clinical, pathologic and treatment data for patients with peritoneal metastases from EC. The outcome measures were morbidity, overall survival (OS), and progression-free survival (PFS). Results In “CRS plus HIPEC” group, 96.7% of women were treated for recurrence, while in “CRS only” 83.3 were treated for primary disease. There was no significant difference between Peritoneal Carcinomatosis Index at laparotomy or Completeness of Cytoreduction score. Grade III and IV complications rates did not significantly differ between “CRS plus HIPEC” group and “CRS only” group (20.7% vs 20.7%, p = 0.739). Survival analysis showed no statistical difference between both groups. Median OS time was 19.2 months in “CRS plus HIPEC” group and 29.7 months in “CRS only” group (p = 0.606). Median PFS survival time was 10.7 months in “CRS plus HIPEC” group and 13.1 months in “CRS only” group (p = 0.511). Conclusion The use of HIPEC combined to CRS did not have any significance as regard the DFS and OS over CRS alone in patients with primary or recurrent peritoneal metastasis of endometrial cancer.
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Affiliation(s)
- Manuel Gomes David
- Département de Chirurgie Oncologique, Institut de Cancérologie de Lorraine, Université de Lorraine, 6 Avenue de Bourgogne, 54519, Vandoeuvre-lès-Nancy, France.
| | - Naoual Bakrin
- Service de Chirurgie Digestive et Endocrinienne, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Julia Salleron
- Institut de Cancérologie de Lorraine, Cellule Data Biostatistiques, Université de Lorraine, 54519, Vandœuvre-lès-Nancy, France
| | - Marie Christine Kaminsky
- Département d'oncologie, Institut de Cancérologie de Lorraine, Université de Lorraine, 54519, Vandœuvre-lès-Nancy, France
| | | | | | | | | | - Olivier Glehen
- Service de Chirurgie Digestive et Endocrinienne, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Frédéric Marchal
- Département de Chirurgie Oncologique, Institut de Cancérologie de Lorraine, Université de Lorraine, 6 Avenue de Bourgogne, 54519, Vandoeuvre-lès-Nancy, France.,CRAN, UMR 7039, CNRS, Université de Lorraine, Boulevard des Aiguillettes, 54506, Vandoeuvre-les-Nancy, France
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Lakhwani P, Agarwal P, Goel A, Nayar N, Pande P, Kumar K. High-Grade Endometrial Cancer-Behaviour and Outcomes at a Tertiary Cancer Centre. Indian J Surg Oncol 2019; 10:662-667. [PMID: 31866730 DOI: 10.1007/s13193-019-00970-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 08/07/2019] [Indexed: 11/25/2022] Open
Abstract
High-grade endometrial carcinomas are a heterogeneous group of clinically aggressive tumours. They include FIGO grade 3 endometrioid adenocarcinoma, uterine papillary serous carcinoma (UPSC), clear cell carcinoma, undifferentiated carcinoma and carcinosarcomas or malignant mixed Mullerian tumour (MMMT). The aim of this study is to look at clinicopathological features and survival outcomes of high-grade endometrial cancers of the uterus in our centre. A tertiary care centre in India. The study design is retrospective with survival analysis. We did a retrospective analysis of all patients admitted with a diagnosis of high-grade uterine carcinoma. Data regarding baseline characteristics, disease profiles, surgical outcomes, complications, extent of surgical staging, duration of surgery, blood loss, length of hospital stay, drain output, wound infection, surgico-pathological stage and grade, tumour size and location, myometrium and lymphovascular invasion, node positivity, adjuvant treatment, overall survival and recurrence-free survival. Survival analysis was done using the Kaplan-Meier method. We had 115 females diagnosed with endometrial cancer. Of these, 40 patients had high-grade endometrial cancer. Mean age at presentation was 64.7 years (range 33-80 years). Of this, endometrioid adenocarcinoma grade III was the commonest (37.5%), followed by UPSC in 32.5% and MMMT in 22.5% patients. Clear cell variant and mixed dedifferentiated variant were reported in 5% and 2.5%, respectively. Over 48 months of follow-up, recurrence was detected in eight patients (20%) and median time to recurrence was 11 months. Mean recurrence-free survival was 32.8 months and mean overall survival was 38.6 months High-grade endometrial cancers are aggressive tumours of postmenopausal women. Surgical staging and combination chemotherapy along with radiation therapy are the mainstay of treatment. In spite of adequate debulking followed by adjuvant therapy, survival remains poor.
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Affiliation(s)
- Prerna Lakhwani
- Gynae Oncology, BL Kapur Super Specialty Hospital, Pusa Road, Delhi, India
| | - Priya Agarwal
- Gynae Oncology, BL Kapur Super Specialty Hospital, Pusa Road, Delhi, India
| | - Ashish Goel
- Surgical oncology, BL Kapur Super Specialty Hospital, Pusa Road, Delhi, India
| | - Nidhi Nayar
- Gynae Oncology, BL Kapur Super Specialty Hospital, Pusa Road, Delhi, India
| | - Pankaj Pande
- Surgical oncology, BL Kapur Super Specialty Hospital, Pusa Road, Delhi, India
| | - Kapil Kumar
- Surgical oncology, BL Kapur Super Specialty Hospital, Pusa Road, Delhi, India
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Zhao D, Ren C, Yao Y, Wang Q, Li F, Li Y, Jiang A, Wang G. Identifying prognostic biomarkers in endometrial carcinoma based on ceRNA network. J Cell Biochem 2019; 121:2437-2446. [PMID: 31692050 DOI: 10.1002/jcb.29466] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 10/08/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE Endometrial carcinoma (EC), a common gynecological malignancy with high incidence, affects the mental and physical health of women. Mounting evidence shows that long noncoding RNAs (lncRNAs), messenger RNAs (mRNAs), and microRNAs (miRNAs) have instrumental roles in various biological processes associated with the pathogenesis of EC. In this research, we intend to further study the mechanism of EC and the potential predictive markers of EC. METHODS First, we obtained original data of EC RNA transcripts from The Cancer Genome Atlas database and performed differential analysis. Subsequently, according to the miRcode online software, relationship pairs of lncRNA-miRNA were constructed, and miRNA-mRNA pairs were established based on miRDB, TargetScan, and miRTarBase. Then, we constructed the competing endogenous RNA (ceRNA) network based on lncRNA-miRNA and miRNA-mRNA pairs. To further explain the function of the ceRNA network and explore the potential prognostic markers, functional enrichment analysis, and survival analysis were carried out. RESULTS The research showed that there were 744 differential expression lncRNAs (DElncRNAs), 164 differential expression miRNAs (DEmiRNAs), and 2447 differential expression mRNAs (DEmRNAs) between EC tissues and normal tissues. Subsequently, we built 103 DEmiRNA-DEmRNA interaction pairs and 369 DElncRNA-DEmiRNA pairs. Then, we established the ceRNA network of EC, including 62 DElncRNAs, 26 DEmiRNAs, and 70 DEmRNAs. Moreover, 10 of 62 lncRNAs, 19 of 70 mRNAs, and 4 of 26 miRNAs that closely related to the survival of EC with P < .05 were obtained. Notably, based on this network, it was found that LINC00261-hsa-mir-31 pair and LINC00261-hsa-mir-211 target pairs could be used as the potential prognostic markers of EC. CONCLUSION This research recommended an available basis for the molecular mechanism of EC and prognosis prediction, which could help guide the subsequent treatments and predict the prognosis for patients with EC.
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Affiliation(s)
- Dongli Zhao
- Clinical Medical Colleges, Weifang Medical University, Weifang, Shandong, China
| | - Chune Ren
- Department of Reproductive Medicine, Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
| | - Yan Yao
- Clinical Medical Colleges, Weifang Medical University, Weifang, Shandong, China
| | - Qinjian Wang
- Clinical Medical Colleges, Weifang Medical University, Weifang, Shandong, China
| | - Fei Li
- Clinical Medical Colleges, Weifang Medical University, Weifang, Shandong, China
| | - Yang Li
- Clinical Medical Colleges, Weifang Medical University, Weifang, Shandong, China
| | - Aifang Jiang
- Department of Reproductive Medicine, Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
| | - Guili Wang
- Department of Reproductive Medicine, Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
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Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for endometrial cancer-derived peritoneal metastases: a systematic review. Clin Exp Metastasis 2019; 36:321-329. [DOI: 10.1007/s10585-019-09970-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 05/06/2019] [Indexed: 12/29/2022]
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Lu M, Zheng J, Xu N, Lin H, Wan S. Postoperative chemotherapy as adjuvant treatment for endometrioid adenocarcinoma: early stage vs late stage. Cancer Chemother Pharmacol 2019; 84:299-305. [PMID: 31037334 DOI: 10.1007/s00280-019-03847-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 04/22/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Adjuvant chemotherapy treatment for different endometrial cancer stages is still debated. We aimed to evaluate the outcome of early (FIGO I-II) vs late stage (FIGO III-IV) endometrial cancer in an institutional experience using chemotherapy only after surgery. METHOD Charts of patients with endometrial carcinoma who underwent surgery with postoperative chemotherapy between February 2012 and December 2017 were retrospectively identified, and the recurrence as well as prognosis were assessed. RESULT Of the 272 eligible endometrioid adenocarcinoma (EA) patients, 127 had received chemotherapy, 145 did not receive chemotherapy; 37 were in late stage (FIGO III-IV) and 235 were in early stage (FIGO I-II). In the late stage group, patients with no chemotherapy had worse overall survival (OS) and recurrence-free survival (RFS) as compared to the patients taking chemotherapy (OS, 28.6% vs 76.4%, P = 0.059; RFS, 17.1% vs 66.4%, P = 0.053). However, in the early stage group, there was no significant difference between the OS and RFS between the patients that were receiving and not receiving chemotherapy (OS, 84.1% vs 93.3%, P = 0.789; RFS, 76.7% vs 72.4%, P = 0.924). Independent predictive factors of recurrence were age over 53 years, histological grade G3, as well as late stages (FIGO III-IV), while independent predictive factors of OS were age over 53 years, deeper depth of myometrial invasion, and late stages (FIGO III-IV). CONCLUSION In late stages, patients with chemotherapy had lower recurrence rate and favorable OS as compared to patients not taking chemotherapy, which was the benefit of postoperative adjuvant chemotherapy, and chemotherapy might be strongly considered in late stage EA.
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Affiliation(s)
- Mengmeng Lu
- Laboratory of Cancer Biomarkers and Liquid Biopsy, Henan University, Kaifeng, 475004, Henan, China
| | - Jiaojiao Zheng
- Laboratory of Cancer Biomarkers and Liquid Biopsy, Henan University, Kaifeng, 475004, Henan, China
| | - Nana Xu
- Laboratory of Cancer Biomarkers and Liquid Biopsy, Henan University, Kaifeng, 475004, Henan, China
| | - Han Lin
- Laboratory of Cancer Biomarkers and Liquid Biopsy, Henan University, Kaifeng, 475004, Henan, China
| | - Shaogui Wan
- Laboratory of Cancer Biomarkers and Liquid Biopsy, Henan University, Kaifeng, 475004, Henan, China. .,Center for Molecular Pathology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, 341000, Jiangxi, China.
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Sardi A, Muñoz‐Zuluaga CA, Sittig M, Diaz‐Montes T. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in seven patients with peritoneal sarcomatosis from uterine sarcoma. Clin Case Rep 2018; 6:1142-1152. [PMID: 29881584 PMCID: PMC5986004 DOI: 10.1002/ccr3.1491] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 02/06/2018] [Accepted: 02/17/2018] [Indexed: 12/14/2022] Open
Abstract
Peritoneal sarcomatosis from uterine sarcoma is a rare disease with no effective treatment and poor prognosis. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) has successful results in peritoneal carcinomatosis from gastrointestinal/gynecological origins. We show that CRS/HIPEC is safe, feasible, and may benefit selected patients with peritoneal sarcomatosis from uterine sarcoma.
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Affiliation(s)
- Armando Sardi
- The Institute for Cancer CareMercy Medical Center227 St. Paul PlaceBaltimore21202‐2001Maryland
| | - Carlos A. Muñoz‐Zuluaga
- The Institute for Cancer CareMercy Medical Center227 St. Paul PlaceBaltimore21202‐2001Maryland
| | - Michelle Sittig
- The Institute for Cancer CareMercy Medical Center227 St. Paul PlaceBaltimore21202‐2001Maryland
| | - Teresa Diaz‐Montes
- The Institute for Cancer CareMercy Medical Center227 St. Paul PlaceBaltimore21202‐2001Maryland
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Cornali T, Sammartino P, Kopanakis N, Christopoulou A, Framarino Dei Malatesta M, Efstathiou E, Spagnoli A, Ciardi A, Biacchi D, Spiliotis J. Cytoreductive Surgery Plus Hyperthermic Intraperitoneal Chemotherapy for Patients with Peritoneal Metastases from Endometrial Cancer. Ann Surg Oncol 2017; 25:679-687. [PMID: 29282600 PMCID: PMC5814516 DOI: 10.1245/s10434-017-6307-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Indexed: 01/26/2023]
Abstract
Background More information is needed for selection of patients with peritoneal metastases from endometrial cancer (EC) to undergo cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC). Methods This study analyzed clinical, pathologic, and treatment data for patients with peritoneal metastases from EC who underwent CRS plus HIPEC at two tertiary centers. The outcome measures were morbidity, overall survival (OS), and progression-free survival (PFS) during a median 5 year follow-up period. Uni- and multivariate analyses were performed to identify significant factors related to outcome. Results A total of 33 patients met the inclusion criteria and completed the follow-up period. At laparotomy, the median peritoneal cancer index (PCI) was 15 (range 3–35). The CRS procedure required a mean 8.3 surgical procedures per patient, and for 22 patients (66.6%), a complete cytoreduction was achieved. The mean hospital stay was 18 days, and major morbidity developed in 21% of the patients. The operative mortality was 3%. When surgery ended, HIPEC was administered with cisplatin 75 mg/m2 for 60 min at 43 °C. During a median follow-up period of 73 months, Kaplan–Meier analysis indicated a 5 year OS of 30% (median 33.1 months) and a PFS of 15.5% (median 18 months). Multivariate analysis identified the completeness of cytoreduction (CC) score as the only significant factor independently influencing OS. Logistic regression for the clinicopathologic variables associated with complete cytoreduction (CC0) for patients with metachronous peritoneal spread from EC who underwent secondary CRS plus HIPEC identified the PCI as the only outcome predictor. Conclusions For selected patients with peritoneal metastases from EC, when CRS leaves no residual disease, CRS plus HIPEC achieves outcomes approaching those for other indications such as colon and ovarian carcinoma.
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Affiliation(s)
- Tommaso Cornali
- Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Rome, Italy
| | - Paolo Sammartino
- Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Rome, Italy. .,Department of Surgery "Pietro Valdoni", Azienda Policlinico Umberto, Rome, Italy.
| | - Nikolaos Kopanakis
- First Department of Surgical Oncology, Metaxa Cancer Hospital, Pireaus, Greece
| | | | | | - Elias Efstathiou
- First Department of Surgical Oncology, Metaxa Cancer Hospital, Pireaus, Greece
| | - Alessandra Spagnoli
- Department of Public Health and Infection Disease, Statistics Section, Sapienza University of Rome, Rome, Italy
| | - Antonio Ciardi
- Department of Radiological Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Daniele Biacchi
- Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Rome, Italy
| | - John Spiliotis
- First Department of Surgical Oncology, Metaxa Cancer Hospital, Pireaus, Greece
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Azzam AZ, Alyahya ZA, Wusaibie AAA, Amin TM. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of pseudomyxoma peritonei: A single-center experience. Indian J Gastroenterol 2017; 36:452-458. [PMID: 29185227 DOI: 10.1007/s12664-017-0799-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 11/05/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Pseudomyxoma peritonei (PMP) results from perforated appendiceal tumors. It is usually diagnosed preoperatively by imaging. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), although aggressive long procedure with high complications rate, was considered the optimal treatment. This study is aiming to study the role of CRS and HIPEC in the management of PMP and assess the outcome. METHODS This is a retrospective study which was conducted at King Faisal Hospital and Research Center, a tertiary care hospital during the period from November 2008 to June 2016. Approval of the Research Advisory Council was obtained. Forty-one procedures of CRS and HIPEC were performed in 38 patients. Using the open abdomen technique, CRS was performed using standard peritonectomy procedures and visceral resections directed toward the complete elimination of tumors from abdominopelvic cavity. HIPEC was performed using mitomycin C in a dose of 30 mg/m2 and allowed to circulate in abdominopelvic cavity for 90 min at 41.0 to 42.2 °C. RESULTS Forty-one procedures were performed in 38 patients. Three procedures were done as repeat CRS and HIPEC. No perioperative mortality. Cystoscopy and bilateral ureteric stents in 35 procedures (85.5%). Hospital stay (range 9-85 days) average is 21 days. Follow up period is 1-84 months, and median follow up is 54 months. Five-year survival rate is 92%. Median 5-year disease-free survival rate is 60%. Two patients died during the follow up period by septic shock and one patient died from disease progression. CONCLUSION CRS and HIPEC is well-tolerated and feasible management for PMP.
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Affiliation(s)
- Ayman Zaki Azzam
- General Surgery Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
- Surgical Oncology Department, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
| | - Zyad Adil Alyahya
- General Surgery Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ahmed Abbas Al Wusaibie
- General Surgery Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Tarek Mahmoud Amin
- Surgical Oncology Department, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Brandl A, Zielinski CB, Raue W, Pratschke J, Rau B. Peritoneal metastases of rare carcinomas treated with cytoreductive surgery and HIPEC - A single center case series. Ann Med Surg (Lond) 2017; 22:7-11. [PMID: 28855982 PMCID: PMC5562045 DOI: 10.1016/j.amsu.2017.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 08/03/2017] [Accepted: 08/03/2017] [Indexed: 12/29/2022] Open
Abstract
Introduction In selected cases, cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is an established treatment for patients suffering from peritoneal metastases from colorectal, ovarian, gastric or appendiceal origin. The effectiveness of this extensive has not been elucidated within other rare diseases by now. Methods We conducted a retrospective analysis of patients treated with CRS for peritoneal carcinomatosis during the period between July 2010 and September 2015. Exclusion criteria were adenocarcinomas of the stomach, colon, neoplasms of the appendix, mesothelioma and ovarian cancers. Aim of this study was to examine the feasibility, complication rate and survival of patients with rare diseases. Results A total of 14 Patients were included: Four rare gynecological tumors, three adenocarcinomas of the small intestine, three retroperitoneal sarcomas, one cholangiocellular carcinoma, one neuroendocrine gastric tumor, one malignant peripheral nerve sheath tumor and one cancer of unknown primary syndrome. In 12 of 14 patients a macroscopically complete tumorresection could be achieved. No patient died during hospitalization. Seven of 14 patients experienced general complication of grade III according to NCI CTCAE V4.0, while two experienced complications of grade IV. Median follow-up and one year overall survival were 15.5 months and 46.8%, respectively. Conclusion For patients with rare tumors, CRS and HIPEC is feasible with an acceptable perioperative morbidity and mortality. To improve knowledge in patient selection and outcome, rare tumors treated with CRS and HIPEC should be documented in central databases (as for example BIG RENAPE, Pierre-Benite, France). The difficulties in deciding of whether to perform CRS and HIPEC for PSM arising from unusual malignancies are remaining. Perioperative morbidity for extensive surgical treatment and HIPEC is acceptable in specialized PSM centers. The prospective registration in tumor registries could help to better define the indications for CRS and HIPEC in rare PSM.
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Affiliation(s)
- Andreas Brandl
- Department of General, Visceral and Transplantation Surgery and Department of General, Visceral, Vascular and Thoracic Surgery, Campus Virchow and Mitte, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Christina Barbara Zielinski
- Department of General, Visceral and Transplantation Surgery and Department of General, Visceral, Vascular and Thoracic Surgery, Campus Virchow and Mitte, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Wieland Raue
- Department of General, Visceral and Transplantation Surgery and Department of General, Visceral, Vascular and Thoracic Surgery, Campus Virchow and Mitte, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Johann Pratschke
- Department of General, Visceral and Transplantation Surgery and Department of General, Visceral, Vascular and Thoracic Surgery, Campus Virchow and Mitte, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Beate Rau
- Department of General, Visceral and Transplantation Surgery and Department of General, Visceral, Vascular and Thoracic Surgery, Campus Virchow and Mitte, Charité, Universitätsmedizin Berlin, Berlin, Germany
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Abu-Zaid A, Abou Al-Shaar H, Azzam A, AlOmar O, Al-Otaibi MF, Amin T, Al-Badawi IA. Routine ureteric stenting before cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy in managing peritoneal carcinomatosis from gynecologic malignancies: a single-center experience. Ir J Med Sci 2017; 186:269-273. [PMID: 27052968 DOI: 10.1007/s11845-016-1452-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 03/21/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND Iatrogenic ureteric injury is a rare, yet serious operative complication in gynecologic procedures and associated with substantial morbidities such as prolonged hospitalization, additional financial-based ureter-related repairing procedures, impaired renal function, and compromised quality of life. Direct visual identification of ureters can be very challenging in managing patients with primary advanced or recurrent disseminated intraperitoneal gynecologic malignancies, who are referred to complex procedures such as cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). AIMS To report our single-center experience (feasibility and morbidity) with prophylactic ureteric stents as a routine practice before CRS+HIPEC procedure in managing peritoneal carcinomatosis (PC) from gynecologic malignancies. METHODS From June-2010 to March-2014, all patients with gynecologic-related PC, managed with CRS+HIPEC, and underwent prophylactic ureteric stents. The data were retrospectively abstracted and analyzed. RESULTS Fifty-three patients were identified. Almost all PC cases were secondary/recurrence presentations (90.6 %) and originated from ovarian cancer (84.9 %). Optimal cytoreduction microscopic residual disease) was achieved in 35 patients (60 %). Average insertion time of ureteric stents was 8.9 ± 3.3 min. Fifty-two patients (98.1 %) received bilateral ureteric stents. Forty-nine patients (92.5 %) had their ureteric stents removed by the end of procedure. No patient experienced major peri-operative urinary tract-related complications. CONCLUSIONS Prophylactic ureteric stents appeared to be feasible, potentially safe, and could reduce the risk of iatrogenic ureteric injuries without incurring an increase in urinary tract-related complications. Prophylactic ureteric stenting does not eliminate the necessity for competent anatomical knowledge, meticulous retroperitoneal dissection and direct intra-operative visualization of ureters.
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Affiliation(s)
- A Abu-Zaid
- Department of Obstetrics and Gynecology, MBC-52, King Faisal Specialist Hospital and Research Center, PO Box 3354, Riyadh, 11211, Saudi Arabia
- King Faisal Oncology Centre, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - H Abou Al-Shaar
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - A Azzam
- King Faisal Oncology Centre, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - O AlOmar
- Department of Obstetrics and Gynecology, MBC-52, King Faisal Specialist Hospital and Research Center, PO Box 3354, Riyadh, 11211, Saudi Arabia
| | - M F Al-Otaibi
- Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - T Amin
- King Faisal Oncology Centre, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - I A Al-Badawi
- Department of Obstetrics and Gynecology, MBC-52, King Faisal Specialist Hospital and Research Center, PO Box 3354, Riyadh, 11211, Saudi Arabia.
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
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Honoré C, Goéré D, Macovei R, Colace L, Benhaim L, Elias D. Peritoneal carcinomatosis from unusual cancer origins: Is there a role for hyperthermic intraperitoneal chemotherapy? J Visc Surg 2016; 153:101-7. [DOI: 10.1016/j.jviscsurg.2015.11.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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15
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Abu-Zaid A, Azzam A, Abuzaid M, Elhassan T, Albadawi N, Alkhatib L, AlOmar O, Alsuhaibani A, Amin T, Al-Badawi IA. Cytoreductive Surgery plus Hyperthermic Intraperitoneal Chemotherapy for Management of Peritoneal Sarcomatosis: A Preliminary Single-Center Experience from Saudi Arabia. Gastroenterol Res Pract 2016; 2016:6567473. [PMID: 27212941 PMCID: PMC4860243 DOI: 10.1155/2016/6567473] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 03/08/2016] [Accepted: 04/07/2016] [Indexed: 02/05/2023] Open
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.
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Affiliation(s)
- Ahmed Abu-Zaid
- 1College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
| | - Ayman Azzam
- 2Faculty of Medicine, Alexandria University, Alexandria 21526, Egypt
- 3King Faisal Oncology Centre, King Faisal Specialist Hospital & Research Centre, Riyadh 11211, Saudi Arabia
| | - Mohammed Abuzaid
- 4Department of Obstetrics and Gynecology, King Fahad Medical City, Riyadh 11525, Saudi Arabia
| | - Tusneem Elhassan
- 3King Faisal Oncology Centre, King Faisal Specialist Hospital & Research Centre, Riyadh 11211, Saudi Arabia
| | - Naryman Albadawi
- 1College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
| | - Lynn Alkhatib
- 1College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
| | - Osama AlOmar
- 5Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh 11211, Saudi Arabia
| | - Abdullah Alsuhaibani
- 3King Faisal Oncology Centre, King Faisal Specialist Hospital & Research Centre, Riyadh 11211, Saudi Arabia
| | - Tarek Amin
- 3King Faisal Oncology Centre, King Faisal Specialist Hospital & Research Centre, Riyadh 11211, Saudi Arabia
| | - Ismail A. Al-Badawi
- 1College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
- 5Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh 11211, Saudi Arabia
- *Ismail A. Al-Badawi:
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