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El-Swaify ST, Laban M, Ali SH, Sabbour M, Refaat MA, Farrag N, Ibrahim EA, Coleman RL. Can fluorescence-guided surgery improve optimal surgical treatment for ovarian cancer? A systematic scoping review of clinical studies. Int J Gynecol Cancer 2023; 33:549-561. [PMID: 36707085 DOI: 10.1136/ijgc-2022-003846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The predicament of achieving optimal surgical intervention faced by surgeons in treating ovarian cancer has driven research into improving intra-operative detection of cancer using fluorescent materials. OBJECTIVE To provide a literature overview on the clinical use of intra-operative fluorescence-guided surgery for ovarian cancer, either for cytoreductive surgery or sentinel lymph node (SLN) biopsy. METHODS The systematic review included studies from June 2002 until October 2021 from PubMed, Web of Science, and Scopus as well as those from a search of related literature. Studies were included if they investigated the use of fluorescence-guided surgery in patients with a diagnosis of ovarian cancer. Authors charted variables related to study characteristics, patient demographics, baseline clinical characteristics, fluorescence-guided surgery material, and treatment details, and surgical, oncological, and survival outcome variables. After screening 2817 potential studies, 24 studies were included. RESULTS Studies investigating the role of fluorescence-guided surgery to visualize tumor deposits or SLN biopsy included the data of 410 and 118 patients, respectively. Six studies used indocyanine green tracer with a mean SLN detection rate of 92.3% with a pelvic and para-aortic detection rate of 94.8% and 96.7%, respectively. The sensitivity, specificity, and positive predictive value for micrometastases detection of OTL38 and 5-aminolevulinc acid at time of cytoreduction were 92.2% vs 79.8%, 67.3% vs 94.8%, and 55.8% vs 95.8%, respectively. CONCLUSION Fluorescence -guided surgery is a technique that may improve the detection rate of micrometastases and SLN identification in ovarian cancer. Further research is needed to establish whether this will lead to improved patient outcomes.
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Affiliation(s)
| | - Mohamed Laban
- Gynecologic Oncology Unit, Ain Shams University Hospitals, Cairo, Egypt
| | - Sara H Ali
- Ain Shams University Hospitals, Cairo, Egypt
| | | | | | | | - Eman A Ibrahim
- Department of Pathology, Ain Shams University Hospitals, Cairo, Egypt
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2
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Harada Y, Murayama Y, Takamatsu T, Otsuji E, Tanaka H. 5-Aminolevulinic Acid-Induced Protoporphyrin IX Fluorescence Imaging for Tumor Detection: Recent Advances and Challenges. Int J Mol Sci 2022; 23:ijms23126478. [PMID: 35742921 PMCID: PMC9223645 DOI: 10.3390/ijms23126478] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/02/2022] [Accepted: 06/07/2022] [Indexed: 12/18/2022] Open
Abstract
5-Aminolevulinic acid (5-ALA) is a natural amino acid and a precursor of heme and chlorophyll. Exogenously administered 5-ALA is metabolized into protoporphyrin IX (PpIX). PpIX accumulates in cancer cells because of the low activity of ferrochelatase, an enzyme that metabolizes PpIX to heme. High expression of 5-ALA influx transporters, such as peptide transporters 1/2, in cancer cells also enhances PpIX production. Because PpIX radiates red fluorescence when excited with blue/violet light, 5-ALA has been used for the visualization of various tumors. 5-ALA photodynamic diagnosis (PDD) has been shown to improve the tumor removal rate in high-grade gliomas and non-muscular invasive bladder cancers. However, 5-ALA PDD remains a challenge as a diagnostic method because tissue autofluorescence interferes with PpIX signals in cases where tumors emit only weak signals, and non-tumorous lesions, such as inflammatory sites, tend to emit PpIX fluorescence. Here, we review the current outline of 5-ALA PDD and strategies for improving its diagnostic applicability for tumor detection, focusing on optical techniques and 5-ALA metabolic pathways in both viable and necrotic tumor tissues.
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Affiliation(s)
- Yoshinori Harada
- Department of Pathology and Cell Regulation, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho Kamigyo-ku, Kyoto 602-8566, Japan;
- Correspondence: ; Tel.: +81-75-251-5322
| | - Yasutoshi Murayama
- Division of Digestive Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho Kamigyo-ku, Kyoto 602-8566, Japan; (Y.M.); (E.O.)
| | - Tetsuro Takamatsu
- Department of Medical Photonics, Kyoto Prefectural University of Medicine, 465 Kajii-cho Kamigyo-ku, Kyoto 602-8566, Japan;
| | - Eigo Otsuji
- Division of Digestive Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho Kamigyo-ku, Kyoto 602-8566, Japan; (Y.M.); (E.O.)
| | - Hideo Tanaka
- Department of Pathology and Cell Regulation, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho Kamigyo-ku, Kyoto 602-8566, Japan;
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3
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Boussedra S, Benoit L, Koual M, Bentivegna E, Nguyen-Xuan HT, Bats AS, Azaïs H. Fluorescence guided surgery to improve peritoneal cytoreduction in epithelial ovarian cancer: A systematic review of available data. Eur J Surg Oncol 2022; 48:1217-1223. [PMID: 35227555 DOI: 10.1016/j.ejso.2022.02.022] [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: 11/12/2021] [Revised: 02/10/2022] [Accepted: 02/17/2022] [Indexed: 11/19/2022] Open
Abstract
During surgery for advanced epithelial ovarian cancer (EOC), the most important prognostic factor is the absence of residual tumor. Invisible microscopic peritoneal metastasis (mPM) are not removed during surgery and can be responsible of peritoneal recurrences. The aim of this current systematic review is to assess the role of fluorescence in evaluating mPM in EOC. We performed a systematic review using bibliographic citations from PubMed, Clinical Trials.gov, Embase, Cochrane Library, and Web of Science databases. MeSH terms for fluorescence, EOC and peritoneal carcinomatosis were combined and not restricted to the English language. The final search was performed on September 1rst, 2021. The primary outcome was to determine the diagnostic accuracy of fluorescence. We also reviewed the different techniques used. Eighty-seven studies were identified. Of these, 10 were included for analysis. The sensitivity and specificity of fluorescence ranged between 66.7-100% and 54.2-100%, respectively. Most importantly, the negative predictive value (NPV) ranged from 90 to 100% Due to the heterogeneity of the studies, no consensus was reached concerning the optimal use of fluorescence in terms of type of dye, type and timing of injection and imager to use. No adverse event was reported. Fluorescence can safely be used in EOC to evaluate mPM with a high NPV. However, a randomized controlled trial is needed to homogenize current practice.
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Affiliation(s)
- Safia Boussedra
- Department of Medical and Surgical Sciences (DIMEC), IRCCS Sant'Orsola-Malpighi, Obstetric and Gynecologic Unit, University of Bologna, Bologna, Italy; Gynecologic and Breast Oncologic Surgery Department, Georges Pompidou European Hospital, APHP. Centre, Université de Paris, Paris, France
| | - Louise Benoit
- Gynecologic and Breast Oncologic Surgery Department, Georges Pompidou European Hospital, APHP. Centre, Université de Paris, Paris, France; INSERM UMR-S 1124, Université de Paris, Centre Universitaire des Saint-Père, Paris, France.
| | - Meriem Koual
- Gynecologic and Breast Oncologic Surgery Department, Georges Pompidou European Hospital, APHP. Centre, Université de Paris, Paris, France; INSERM UMR-S 1124, Université de Paris, Centre Universitaire des Saint-Père, Paris, France
| | - Enrica Bentivegna
- Gynecologic and Breast Oncologic Surgery Department, Georges Pompidou European Hospital, APHP. Centre, Université de Paris, Paris, France
| | - Huyen-Thu Nguyen-Xuan
- Gynecologic and Breast Oncologic Surgery Department, Georges Pompidou European Hospital, APHP. Centre, Université de Paris, Paris, France
| | - Anne-Sophie Bats
- Gynecologic and Breast Oncologic Surgery Department, Georges Pompidou European Hospital, APHP. Centre, Université de Paris, Paris, France; INSERM UMR-S 1147, Université de Paris, Centre de Recherche des Cordeliers, Paris, France
| | - Henri Azaïs
- Gynecologic and Breast Oncologic Surgery Department, Georges Pompidou European Hospital, APHP. Centre, Université de Paris, Paris, France; INSERM UMR-S 1147, Université de Paris, Centre de Recherche des Cordeliers, Paris, France
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4
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van Vliet-Pérez SM, van de Berg NJ, Manni F, Lai M, Rijstenberg L, Hendriks BHW, Dankelman J, Ewing-Graham PC, Nieuwenhuyzen-de Boer GM, van Beekhuizen HJ. Hyperspectral Imaging for Tissue Classification after Advanced Stage Ovarian Cancer Surgery-A Pilot Study. Cancers (Basel) 2022; 14:cancers14061422. [PMID: 35326577 PMCID: PMC8946803 DOI: 10.3390/cancers14061422] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/24/2022] [Accepted: 03/08/2022] [Indexed: 02/05/2023] Open
Abstract
The most important prognostic factor for the survival of advanced-stage epithelial ovarian cancer (EOC) is the completeness of cytoreductive surgery (CRS). Therefore, an intraoperative technique to detect microscopic tumors would be of great value. The aim of this pilot study is to assess the feasibility of near-infrared hyperspectral imaging (HSI) for EOC detection in ex vivo tissue samples. Images were collected during CRS in 11 patients in the wavelength range of 665−975 nm, and processed by calibration, normalization, and noise filtering. A linear support vector machine (SVM) was employed to classify healthy and tumorous tissue (defined as >50% tumor cells). Classifier performance was evaluated using leave-one-out cross-validation. Images of 26 tissue samples from 10 patients were included, containing 26,446 data points that were matched to histopathology. Tumorous tissue could be classified with an area under the curve of 0.83, a sensitivity of 0.81, a specificity of 0.70, and Matthew’s correlation coefficient of 0.41. This study paves the way to in vivo and intraoperative use of HSI during CRS. Hyperspectral imaging can scan a whole tissue surface in a fast and non-contact way. Our pilot study demonstrates that HSI and SVM learning can be used to discriminate EOC from surrounding tissue.
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Affiliation(s)
- Sharline M. van Vliet-Pérez
- Department of Biomechanical Engineering, Delft University of Technology, 2628 CD Delft, The Netherlands; (N.J.v.d.B.); (B.H.W.H.); (J.D.)
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- Correspondence:
| | - Nick J. van de Berg
- Department of Biomechanical Engineering, Delft University of Technology, 2628 CD Delft, The Netherlands; (N.J.v.d.B.); (B.H.W.H.); (J.D.)
- Department of Gynecological Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (G.M.N.-d.B.); (H.J.v.B.)
| | - Francesca Manni
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands; (F.M.); (M.L.)
| | - Marco Lai
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands; (F.M.); (M.L.)
| | - Lucia Rijstenberg
- Department of Pathology, Erasmus University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (L.R.); (P.C.E.-G.)
| | - Benno H. W. Hendriks
- Department of Biomechanical Engineering, Delft University of Technology, 2628 CD Delft, The Netherlands; (N.J.v.d.B.); (B.H.W.H.); (J.D.)
| | - Jenny Dankelman
- Department of Biomechanical Engineering, Delft University of Technology, 2628 CD Delft, The Netherlands; (N.J.v.d.B.); (B.H.W.H.); (J.D.)
| | - Patricia C. Ewing-Graham
- Department of Pathology, Erasmus University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (L.R.); (P.C.E.-G.)
| | - Gatske M. Nieuwenhuyzen-de Boer
- Department of Gynecological Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (G.M.N.-d.B.); (H.J.v.B.)
- Department of Gynecology, Albert Schweitzer Hospital, 3318 AT Dordrecht, The Netherlands
| | - Heleen J. van Beekhuizen
- Department of Gynecological Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (G.M.N.-d.B.); (H.J.v.B.)
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Wang X, Chen Y, Wang Y, Wang B, Zhang J, Jian X. Expression, Regulation, and Role of an Oligopeptide Transporter: PEPT1 in Tumors. Curr Med Chem 2022; 29:1596-1605. [PMID: 35546503 DOI: 10.2174/0929867328666210707170214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/04/2021] [Accepted: 04/21/2021] [Indexed: 11/22/2022]
Abstract
:
PEPT1 is a vital member of the proton-dependent oligopeptide transporters
family (POTs). Many studies have confirmed that PEPT1 plays a critical role in the absorption
of dipeptides, tripeptides, and pseudopeptides in the intestinal tract. In recent
years, several studies have found that PEPT1 is highly expressed in malignant tumor tissues
and cells. The abnormal expression of PEPT1 in tumors may be closely related to the
progress of tumors, and hence, could be considered as a potential molecular biomarker for
the diagnosis, treatment, and prognosis in malignant tumors. Furthermore, PEPT1 can be
used to mediate the targeted delivery of anti-tumor drugs. Herein, the expression, regulation,
and role of PEPT1 in tumors in recent years have been reviewed.
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Affiliation(s)
- Xi Wang
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin Institute
of Digestive Disease, Tianjin 300052, China
- Tianjin Baodi Hospital/Baodi Clinical College of Tianjin
Medical University, Tianjin 300052, China
| | - Yiming Chen
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin Institute
of Digestive Disease, Tianjin 300052, China
| | - Yongjuan Wang
- Department of Gastroenterology and Hepatology, The Second
Affiliated Hospital of Hebei Medical University, Hebei, China
| | - Bangmao Wang
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin Institute
of Digestive Disease, Tianjin 300052, China
| | - Jie Zhang
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin Institute
of Digestive Disease, Tianjin 300052, China
| | - Xu Jian
- Central Laboratory, Tianjin Medical University
General Hospital, Tianjin, 300052, China
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6
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Luan S, Tran NT, Xue HY, Wong HL. Development of a high payload, cancer-targeting liposomes of methyl aminolevulinate for intraoperative photodynamic diagnosis/therapy of peritoneal carcinomatosis. Int J Pharm 2021; 602:120612. [PMID: 33905866 DOI: 10.1016/j.ijpharm.2021.120612] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/26/2021] [Accepted: 04/11/2021] [Indexed: 01/05/2023]
Abstract
Methyl aminolevulinate (MAL) is a photosensitizer topically used for photodynamic diagnosis (PDD) and photodynamic therapy (PDT) of skin pre-cancers and cancers. In this study, our goal is to expand the application of MAL to dual intraoperative PDD and PDT of peritoneal carcinomatosis. A new liposomal MAL formulation (lipMAL) designed for systemic or intraperitoneal administration was developed. LipMALs prepared by ammonium sulfate gradient technique achieved MAL payload up to 18% (w/w) with drug encapsulation efficiency in the range of 15.1-31.5%. All lipMALs demonstrated controlled MAL release behavior, and achieved strong fluorescence in cancer cells (SKOV3) but minimal fluorescence in non-cancer peritoneal cells (B14FAF28-G3). LipMALs led to significantly higher fluorescence levels than free MAL groups (P < 0.05), up to 6.8-fold of the free MAL fluorescence levels in SKOV3 cells. The PDD performance of lipMALs was also compared with free MAL in SKOV3/ B14FAF28-G3 co-cultures simulating ovarian cancer micrometastases on peritoneal surface. The lipMAL-treated cancer colonies glew more brightly than the free MAL treated colonies and were clearly distinguishable from the dim peritoneum background with unaided eyes. LipMAL also achieved significantly stronger anticancer PDT effects than free MAL both in terms of cell viability and colony-formation (P < 0.05) while demonstrating minimal dark toxicity. To conclude, a new promising aid for the surgeons to achieve more complete resection of tumors and PC micrometastases and clean up any residual cancer cells undetected was developed.
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Affiliation(s)
- Shijie Luan
- Department of Pharmaceutical Sciences, Temple University School of Pharmacy, 3307 North Broad Street, Philadelphia, PA 19140, USA
| | - Ngoc T Tran
- Department of Pharmaceutical Sciences, Temple University School of Pharmacy, 3307 North Broad Street, Philadelphia, PA 19140, USA
| | - Hui-Yi Xue
- Department of Pharmaceutical Sciences, Temple University School of Pharmacy, 3307 North Broad Street, Philadelphia, PA 19140, USA.
| | - Ho-Lun Wong
- Department of Pharmaceutical Sciences, Temple University School of Pharmacy, 3307 North Broad Street, Philadelphia, PA 19140, USA.
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7
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Sinukumar S, Rajan F, Mehta S, Damodaran D, Zaveri S, Kammar P, Bhatt A. A comparison of outcomes following total and selective peritonectomy performed at the time of interval cytoreductive surgery for advanced serous epithelial ovarian, fallopian tube and primary peritoneal cancer - A study by INDEPSO. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2021; 47:75-81. [PMID: 30857879 DOI: 10.1016/j.ejso.2019.02.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 02/22/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To compare clinical outcomes following total and selective peritonectomy performed during interval cytoreductive surgery (CRS) for stage IIIC/IVA serous epithelial ovarian cancer. METHODS In this retrospective study, extent of peritonectomy was classified as total parietal peritonectomy (TPP) which comprised of removal of the entire parietal peritoneum and the greater and lesser omenta or selective parietal peritonectomy (SPP) that included 1/>1 of parietal peritonectomies performed to resect sites of residual disease. A comparison of patient and disease characteristics, morbidity, mortality and survival outcomes between the two groups was made. RESULTS From January 2013 to December 2017, 79 patients underwent CRS (TPP-30, SPP-49) with or without intraperitoneal chemotherapy (IPC). The median PCI was 14 for TPP and 8 for SPP. The 90-day grade 3-4 morbidity (23.3% for TPP, 14.2% for SPP, p = 0.58) the 90-day mortality was similar (p = 0.58). The median disease free survival (DFS) was 37 months for SPP and 33 months for TPP (p = 0.47) and median overall survival (OS) not reached for both. The 3-year OS was 95% for TPP and 70.8% for SPP (p = 0.06). The only independent predictor of OS was grade 3-4 morbidity (p = 0.01) and not TPP (p = 0.09). Microscopic residual disease was seen in 23.3% with normal looking peritoneum in TPP group. CONCLUSIONS TPP was not associated with increased morbidity compared to SPP. There was a trend towards a longer OS in the TPP group and the finding of residual disease in 'normal looking' peritoneum' warrants prospective evaluation of the benefit of TPP in this setting.
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MESH Headings
- Adult
- Aged
- Female
- Humans
- Middle Aged
- Antineoplastic Combined Chemotherapy Protocols
- Carcinoma, Ovarian Epithelial/drug therapy
- Carcinoma, Ovarian Epithelial/mortality
- Carcinoma, Ovarian Epithelial/pathology
- Carcinoma, Ovarian Epithelial/surgery
- Cytoreduction Surgical Procedures
- Fallopian Tube Neoplasms/drug therapy
- Fallopian Tube Neoplasms/mortality
- Fallopian Tube Neoplasms/pathology
- Fallopian Tube Neoplasms/surgery
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/mortality
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/surgery
- Neoplasm Staging
- Neoplasm, Residual/drug therapy
- Neoplasm, Residual/mortality
- Neoplasm, Residual/pathology
- Neoplasm, Residual/surgery
- Peritoneal Neoplasms/drug therapy
- Peritoneal Neoplasms/mortality
- Peritoneal Neoplasms/pathology
- Peritoneal Neoplasms/surgery
- Postoperative Complications
- Retrospective Studies
- Survival Rate
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Affiliation(s)
- Snita Sinukumar
- Department of Surgical Oncology, Jehangir Hospital, Pune, India
| | - Firoz Rajan
- Department of Surgical Oncology, Kovai Medical Center, Coimbatore, India
| | - Sanket Mehta
- Department of Surgical Oncology, Saifee Hospital, Mumbai, India
| | - Dileep Damodaran
- Department of Surgical Oncology, MVR Cancer Centre and Research Institute, Calicut, India
| | | | - Praveen Kammar
- Department of Surgical Oncology, Saifee Hospital, Mumbai, India
| | - Aditi Bhatt
- Department of Surgical Oncology, Zydus Hospital, Ahmedabad, India.
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Kim HI, Wilson BC. Photodynamic Diagnosis and Therapy for Peritoneal Carcinomatosis from Gastrointestinal Cancers: Status, Opportunities, and Challenges. J Gastric Cancer 2020; 20:355-375. [PMID: 33425438 PMCID: PMC7781745 DOI: 10.5230/jgc.2020.20.e39] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 12/15/2020] [Indexed: 12/21/2022] Open
Abstract
Selective accumulation of a photosensitizer and the subsequent response in only the light-irradiated target are advantages of photodynamic diagnosis and therapy. The limited depth of the therapeutic effect is a positive characteristic when treating surface malignancies, such as peritoneal carcinomatosis. For photodynamic diagnosis (PDD), adjunctive use of aminolevulinic acid- protoporphyrin IX-guided fluorescence imaging detects cancer nodules, which would have been missed during assessment using white light visualization only. Furthermore, since few side effects have been reported, this has the potential to become a vital component of diagnostic laparoscopy. A variety of photosensitizers have been examined for photodynamic therapy (PDT), and treatment protocols are heterogeneous in terms of photosensitizer type and dose, photosensitizer-light time interval, and light source wavelength, dose, and dose rate. Although several studies have suggested that PDT has favorable effects in peritoneal carcinomatosis, clinical trials in more homogenous patient groups are required to identify the true benefits. In addition, major complications, such as bowel perforation and capillary leak syndrome, need to be reduced. In the long term, PDD and PDT are likely to be successful therapeutic options for patients with peritoneal carcinomatosis, with several options to optimize the photosensitizer and light delivery parameters to improve safety and efficacy.
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Affiliation(s)
- Hyoung-Il Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Seoul, Korea
- Open NBI Convergence Technology Research Laboratory, Severance Hospital, Seoul, Korea
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Brian C. Wilson
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Medical Biophysics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Xu S, Bulin AL, Hurbin A, Elleaume H, Coll JL, Broekgaarden M. Photodynamic Diagnosis and Therapy for Peritoneal Carcinomatosis: Emerging Perspectives. Cancers (Basel) 2020; 12:cancers12092491. [PMID: 32899137 PMCID: PMC7563129 DOI: 10.3390/cancers12092491] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/24/2020] [Accepted: 09/01/2020] [Indexed: 12/22/2022] Open
Abstract
Simple Summary Peritoneal carcinomatosis, the formation of wide-spread metastases throughout the abdominal cavity, remains challenging to diagnose and treat. Photodynamic diagnosis and photodynamic therapy are promising approaches for the diagnosis and treatment of peritoneal carcinomatosis, which use photosensitizers for fluorescence detection or photochemical treatment of (micro) metastases. With the aim of highlighting the potential of this theranostic approach, this review outlines the clinical state of the art in the use of photodynamic diagnosis and therapy for peritoneal carcinomatosis, identifies the major challenges, and provides emerging perspectives from preclinical studies to address these challenges. We conclude that the development of novel illumination strategies and targeted photonanomedicines may aid in achieving more efficient cytoreductive surgery. In addition to combination treatments with chemo-, and radiotherapy, such approaches hold significant promise to improve the outlook of patients with peritoneal carcinomatosis. Abstract Peritoneal carcinomatosis occurs frequently in patients with advanced stage gastrointestinal and gynecological cancers. The wide-spread peritoneal micrometastases indicate a poor outlook, as the tumors are difficult to diagnose and challenging to completely eradicate with cytoreductive surgery and chemotherapeutics. Photodynamic diagnosis (PDD) and therapy (PDT), modalities that use photosensitizers for fluorescence detection or photochemical treatment of cancer, are promising theranostic approaches for peritoneal carcinomatosis. This review discusses the leading clinical trials, identifies the major challenges, and presents potential solutions to advance the use of PDD and PDT for the treatment of peritoneal carcinomatosis. While PDD for fluorescence-guided surgery is practically feasible and has achieved clinical success, large randomized trials are required to better evaluate the survival benefits. Although PDT is feasible and combines well with clinically used chemotherapeutics, poor tumor specificity has been associated with severe morbidity. The major challenges for both modalities are to increase the tumor specificity of the photosensitizers, to efficiently treat peritoneal microtumors regardless of their phenotypes, and to improve the ability of the excitation light to reach the cancer tissues. Substantial progress has been achieved in (1) the development of targeted photosensitizers and nanocarriers to improve tumor selectivity, (2) the design of biomodulation strategies to reduce treatment heterogeneity, and (3) the development of novel light application strategies. The use of X-ray-activated PDT during whole abdomen radiotherapy may also be considered to overcome the limited tissue penetration of light. Integrated approaches that take advantage of PDD, cytoreductive surgery, chemotherapies, PDT, and potentially radiotherapy, are likely to achieve the most effective improvement in the management of peritoneal carcinomatosis.
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Affiliation(s)
- Si Xu
- Institute for Advanced Biosciences, INSERM U1209, CNRS UMR5309, Université Grenoble-Alpes, 38700 La Tronche, France; (S.X.); (A.H.); (M.B.)
- Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Anne-Laure Bulin
- Synchrotron Radiation for Biomedicine, UA07 INSERM, Université Grenoble-Alpes, European Synchrotron Radiation Facility, Biomedical Beamline, 38043 Grenoble CEDEX 9, France; (A.-L.B.); (H.E.)
| | - Amandine Hurbin
- Institute for Advanced Biosciences, INSERM U1209, CNRS UMR5309, Université Grenoble-Alpes, 38700 La Tronche, France; (S.X.); (A.H.); (M.B.)
| | - Hélène Elleaume
- Synchrotron Radiation for Biomedicine, UA07 INSERM, Université Grenoble-Alpes, European Synchrotron Radiation Facility, Biomedical Beamline, 38043 Grenoble CEDEX 9, France; (A.-L.B.); (H.E.)
| | - Jean-Luc Coll
- Institute for Advanced Biosciences, INSERM U1209, CNRS UMR5309, Université Grenoble-Alpes, 38700 La Tronche, France; (S.X.); (A.H.); (M.B.)
- Correspondence:
| | - Mans Broekgaarden
- Institute for Advanced Biosciences, INSERM U1209, CNRS UMR5309, Université Grenoble-Alpes, 38700 La Tronche, France; (S.X.); (A.H.); (M.B.)
- Synchrotron Radiation for Biomedicine, UA07 INSERM, Université Grenoble-Alpes, European Synchrotron Radiation Facility, Biomedical Beamline, 38043 Grenoble CEDEX 9, France; (A.-L.B.); (H.E.)
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10
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Development of a near infrared protein nanoprobe targeting Thomsen-Friedenreich antigen for intraoperative detection of submillimeter nodules in an ovarian peritoneal carcinomatosis mouse model. Biomaterials 2020; 241:119908. [PMID: 32126396 DOI: 10.1016/j.biomaterials.2020.119908] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 02/12/2020] [Accepted: 02/19/2020] [Indexed: 02/07/2023]
Abstract
The epithelial ovarian cancer is one of the most lethal gynecological malignancy due to its late diagnostic and many relapses observed after first line of treatment. Once diagnose, the most important prognostic factor is the completeness of cytoreductive surgery. To achieve this goal, surgeons have to pinpoint and remove nodules, especially the smallest nodules. Recent advances in fluorescence-guided surgery led us to develop a recombinant lectin as a nanoprobe for the microscopic detection of nodules in the peritoneal cavity of tumor-bearing mice. This lectin has an intrinsic specificity for a carcinoma-associated glycan biomarker, the Thomsen-Friedenreich antigen. In this study, after its labelling by a near infrared dye, we first demonstrated that this nanoprobe allowed indirect detection of nodules already implanted in the peritoneal cavity, through tumor microenvironment targeting. Secondly, in a protocol mimicking the scattering of cells during surgery, we obtained a direct and long-lasting detection of tumor cells in vivo. This lectin as already been described as a nanocontainer able to do targeted delivery of a therapeutic compound to carcinoma cells. Future developments will focus on the combination of the nanoprobe and nanocontainer aspects in an intraperitoneal nanotheranostic approach.
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11
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Bhatt A, Glehen O. Extent of Peritoneal Resection for Peritoneal Metastases: Looking Beyond a Complete Cytoreduction. Ann Surg Oncol 2020; 27:1458-1470. [PMID: 31965374 DOI: 10.1245/s10434-020-08208-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Indexed: 12/17/2022]
Abstract
Completeness of cytoreduction is one of the most important prognostic factors impacting outcomes of cytoreductive surgery (CRS). To what extent the surrounding normal peritoneum needs to be removed is not known. We hypothesized that the extent of peritoneal resection should be different for different tumors and performed this study to find evidence to support this rationale. To determine the extent of resection of surrounding tissue for any tumor, the mechanisms of tumor development and spread, tumor morphology, the possibility of finding disease in the surrounding normal tissue, and the pattern of lymph node metastases should be known. Surgical resections also depend on patterns of recurrence and the impact of varying extent of resection on survival. We performed a review of literature pertaining to pathways and patterns of peritoneal cancer spread to determine the scientific basis for the extent of peritonectomy. We also reviewed studies comparing less and more extensive peritoneal resection. There is no consensus on the extent of lymphadenectomy required for most PM. Based on this review, we provide recommendations for the extent of peritoneal resection and the extent of lymph node dissection that should be performed for some common peritoneal tumors and identify areas that require further research. We propose that a systematic method of synoptic reporting of pathological specimens of CRS should be developed to capture information regarding the disease distribution within the peritoneal cavity and morphology of PM from different tumors. This can in future be used to establish standard guidelines for such resections.
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Affiliation(s)
- Aditi Bhatt
- Department of Surgical Oncology, Zydus Hospital, Ahmedabad, India
| | - Olivier Glehen
- Department of Surgical Oncology, Centre Hospitalier Lyon-Sud, Lyon, France.
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12
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Patterns of pathological response to neoadjuvant chemotherapy and its clinical implications in patients undergoing interval cytoreductive surgery for advanced serous epithelial ovarian cancer- A study by the Indian Network for Development of Peritoneal Surface Oncology (INDEPSO). Eur J Surg Oncol 2019; 45:666-671. [DOI: 10.1016/j.ejso.2019.01.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 12/21/2018] [Accepted: 01/06/2019] [Indexed: 01/27/2023] Open
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13
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Kerbage Y, Canlorbe G, Estevez JP, Grabarz A, Mordon S, Uzan C, Collinet P, Azaïs H. [Microscopic peritoneal metastases of epithelial ovarian cancers. Clinical relevance, diagnostic and therapeutic tools]. ACTA ACUST UNITED AC 2018; 46:497-502. [PMID: 29656069 DOI: 10.1016/j.gofs.2018.03.011] [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: 12/31/2017] [Indexed: 10/17/2022]
Abstract
Understanding the biology and progression mechanisms of peritoneal metastases in ovarian epithelial cancers (EOC) is important because peritoneal carcinomatosis is present or will occur during surveillance of a majority of patients. Despite the clinical remission achieved after complete macroscopic cytoreductive surgery and platinum-based chemotherapy, 60% of patients will develop peritoneal recurrence. This suggests that microscopic lesions, which are not eradicated by surgery may be present and may participate in the mechanisms leading to peritoneal recurrence. This paper discusses current available data on microscopic peritoneal metastases, their diagnosis and their treatment. We reviewed all publications dealing with microscopic peritoneal metastases of EOC between 1980 and 2017. The most recent and most relevant publications dealing with the treatment modalities of these metastases were selected. Peritoneal and epiploic microscopic localizations would occur in 1.2 to 15.1% of cases at early-stage and are not treated during conventional surgery. They could represent a potential therapeutic target. Local treatments (intraperitoneal chemotherapy, photodynamic therapy, fluorescence-guided surgery) seem to be necessary in addition to surgery and chemotherapy and may help reduce the risk of peritoneal recurrence. The place of these treatments in the management of EOC remains to be defined by subsequent researches.
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Affiliation(s)
- Y Kerbage
- Service de chirurgie gynécologique, CHU de Lille, 59000 Lille, France; Inserm, U1189, ONCO-THAI, thérapies laser assistées par l'imagerie, 59000 Lille, France
| | - G Canlorbe
- Service de chirurgie et oncologie gynécologique et mammaire, hôpitaux universitaires Pitié-Salpêtrière-Charles-Foix, Pitié-Salpêtrière, AP-HP, 47/83, boulevard de l'Hôpital, 75013 Paris, France
| | - J P Estevez
- Service de chirurgie gynécologique, CHU de Lille, 59000 Lille, France
| | - A Grabarz
- Service de chirurgie gynécologique, CHU de Lille, 59000 Lille, France; Inserm, U1189, ONCO-THAI, thérapies laser assistées par l'imagerie, 59000 Lille, France
| | - S Mordon
- Inserm, U1189, ONCO-THAI, thérapies laser assistées par l'imagerie, 59000 Lille, France
| | - C Uzan
- Service de chirurgie et oncologie gynécologique et mammaire, hôpitaux universitaires Pitié-Salpêtrière-Charles-Foix, Pitié-Salpêtrière, AP-HP, 47/83, boulevard de l'Hôpital, 75013 Paris, France
| | - P Collinet
- Service de chirurgie gynécologique, CHU de Lille, 59000 Lille, France; Inserm, U1189, ONCO-THAI, thérapies laser assistées par l'imagerie, 59000 Lille, France
| | - H Azaïs
- Inserm, U1189, ONCO-THAI, thérapies laser assistées par l'imagerie, 59000 Lille, France; Service de chirurgie et oncologie gynécologique et mammaire, hôpitaux universitaires Pitié-Salpêtrière-Charles-Foix, Pitié-Salpêtrière, AP-HP, 47/83, boulevard de l'Hôpital, 75013 Paris, France.
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14
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Azaïs H, Canlorbe G, Kerbage Y, Grabarz A, Collinet P, Mordon S. Image-guided surgery in gynecologic oncology. Future Oncol 2017; 13:2321-2328. [PMID: 29121779 DOI: 10.2217/fon-2017-0253] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Image-guided surgery is a relevant way to reduce surgical morbidity and maximize cytoreductive surgery approach especially in ovarian cancer. Sentinel lymph node detection is a promising approach to avoid radical lymph node dissection and is slightly becoming standard in daily practice in endometrial and cervical cancer surgery even if it needs to be evaluated more precisely. Regarding carcinomatosis of ovarian origin, detection and treatment of microscopic disease could be appropriate to avoid local recurrences. Photodiagnosis and photodynamic therapy are innovative techniques that allow to precise limits of excision (fluorescence-guided surgery) and to treat microscopic disease. Further developments of those strategies are necessary to become standard diagnosis tools and treatment options.
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Affiliation(s)
- Henri Azaïs
- Department of Gynecological & Breast Surgery & Oncology, AP-HP, Pitié-Salpêtrière, 83 Boulevard de l'Hôpital, 75013 Paris, France; Pierre et Marie Curie University, Paris 6, France.,INSERM, U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, F-59000 Lille, France
| | - Geoffroy Canlorbe
- Department of Gynecological & Breast Surgery & Oncology, AP-HP, Pitié-Salpêtrière, 83 Boulevard de l'Hôpital, 75013 Paris, France; Pierre et Marie Curie University, Paris 6, France
| | - Yohan Kerbage
- INSERM, U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, F-59000 Lille, France.,Department of Gynecologic Surgery, CHU Lille, F-59000 Lille, France
| | - Anne Grabarz
- INSERM, U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, F-59000 Lille, France.,Department of Gynecologic Surgery, CHU Lille, F-59000 Lille, France
| | - Pierre Collinet
- INSERM, U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, F-59000 Lille, France.,Department of Gynecologic Surgery, CHU Lille, F-59000 Lille, France
| | - Serge Mordon
- INSERM, U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, F-59000 Lille, France
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15
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Nowacki M, Peterson M, Kloskowski T, McCabe E, Guiral DC, Polom K, Pietkun K, Zegarska B, Pokrywczynska M, Drewa T, Roviello F, Medina EA, Habib SL, Zegarski W. Nanoparticle as a novel tool in hyperthermic intraperitoneal and pressurized intraperitoneal aerosol chemotheprapy to treat patients with peritoneal carcinomatosis. Oncotarget 2017; 8:78208-78224. [PMID: 29100461 PMCID: PMC5652850 DOI: 10.18632/oncotarget.20596] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 08/15/2017] [Indexed: 12/11/2022] Open
Abstract
The treatment of peritoneal surface malignances has changed considerably over the last thirty years. Unfortunately, the palliative is the only current treatment for peritoneal carcinomatosis (PC). Two primary intraperitoneal chemotherapeutic methods are used. The first is combination of cytoreductive surgery (CRS) and Hyperthermic IntraPEritoneal Chemotherapy (HIPEC), which has become the gold standard for many cases of PC. The second is Pressurized IntraPeritoneal Aerosol Chemotheprapy (PIPAC), which is promising direction to minimally invasive as safedrug delivery. These methods were improved through multicenter studies and clinical trials that yield important insights and solutions. Major method development has been made through nanomedicine, specifically nanoparticles. Here, we are presenting the latest advances of nanoparticles and their application to precision diagnostics and improved treatment strategies for PC. These advances will likely develop both HIPEC and PIPAC methods that used for in vitro and in vivo studies. Several benefits of using nanoparticles will be discussed including: 1) Nanoparticles as drug delivery systems; 2) Nanoparticles and Near Infrred (NIR) Irradiation; 3) use of nanoparticles in perioperative diagnostic and individualized treatment planning; 4) use of nanoparticles as anticancer dressing's, hydrogels and as active beeds for optimal reccurence prevention; and 5) finally the curent in vitro and in vivo studies and clinical trials of nanoparticles. The current review highlighted use of nanoparticles as novel tools in improving drug delivery to be effective for treatment patients with peritoneal carcinomatosis.
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Affiliation(s)
- Maciej Nowacki
- Chair of Department of Surgical Oncology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Oncology Centre of Franciszek Łukaszczyk Memorial Hospital, Bydgoszcz, Poland
| | - Margarita Peterson
- Department of Plastic and Reconstructive Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Tomasz Kloskowski
- Chair of Urology, Department of Regenerative Medicine, Ludwik Rydygier's Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Toruń, Poland
| | - Eleanor McCabe
- Department of Plastic and Reconstructive Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Delia Cortes Guiral
- Department of General Surgery (Peritoneal Surface Surgical Oncology), Fundación Jiménez Díaz Hospital, Madrid, Spain
| | - Karol Polom
- General Surgery and Surgical Oncology Department, University of Siena, Siena, Italy
- Department of Surgical Oncology, Medical University of Gdansk, Gdansk, Poland
| | - Katarzyna Pietkun
- Chair of Cosmetology and Aesthetic Dermatology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun. Bydgoszcz, Poland
| | - Barbara Zegarska
- Chair of Cosmetology and Aesthetic Dermatology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun. Bydgoszcz, Poland
| | - Marta Pokrywczynska
- Chair of Urology, Department of Regenerative Medicine, Ludwik Rydygier's Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Toruń, Poland
| | - Tomasz Drewa
- Chair of Urology, Department of Regenerative Medicine, Ludwik Rydygier's Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Toruń, Poland
| | - Franco Roviello
- Chair of Cosmetology and Aesthetic Dermatology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun. Bydgoszcz, Poland
| | - Edward A. Medina
- Department of Pathology, University of Texas Health, San Antonio, TX, USA
| | - Samy L. Habib
- Department of Cell Systems and Anatomy, University of Texas Health Geriatric Research Education, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Wojciech Zegarski
- Chair of Department of Surgical Oncology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Oncology Centre of Franciszek Łukaszczyk Memorial Hospital, Bydgoszcz, Poland
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16
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Yonemura Y, Endo Y, Canbay E, Liu Y, Ishibashi H, Mizumoto A, Hirano M, Imazato Y, Takao N, Ichinose M, Noguchi K, Li Y, Wakama S, Yamada K, Hatano K, Shintani H, Yoshitake H, Ogura SI. Photodynamic Detection of Peritoneal Metastases Using 5-Aminolevulinic Acid (ALA). Cancers (Basel) 2017; 9:cancers9030023. [PMID: 28257041 PMCID: PMC5366818 DOI: 10.3390/cancers9030023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 02/08/2017] [Accepted: 02/16/2017] [Indexed: 12/14/2022] Open
Abstract
In the past, peritoneal metastasis (PM) was considered as a terminal stage of cancer. From the early 1990s, however, a new comprehensive treatment consisting of cytoreductive surgery and perioperative chemotherapy has been established to improve long-term survival for selected patients with PM. Among prognostic indicators after the treatment, completeness of cytoreduction is the most independent predictors of survival. However, peritoneal recurrence is a main cause of recurrence, even after complete cytoreduction. As a cause of peritoneal recurrence, small PM may be overlooked at the time of cytoreductive surgery (CRS), therefore, development of a new method to detect small PM is desired. Recently, photodynamic diagnosis (PDD) was developed for detection of PM. The objectives of this review were to evaluate whether PDD using 5-aminolevulinic acid (ALA) could improve detection of small PM.
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Affiliation(s)
- Yutaka Yonemura
- NPO Organization to support Peritoneal Surface Malignancy Treatment, 510 Fukushima-Cho, Shimogyou-Ku, Kyoto 600-8189, Japan.
- Peritoneal Surface Malignancy Center, Kishiwada Tokushukai Hospital, 4-27-1 Kamori-Cho, Kishiwada City, Osaka 596-8522, Japan.
- Department of General Surgery, Kusatsu General Hospital, 1660 Yabase, Kusatsu City, Shiga 525-8585, Japan.
| | - Yoshio Endo
- Central Research Resource Center, Cancer Research Institute, Kanazawa University, Kakuma-machi, Kanazawa 920-1192, Japan.
| | - Emel Canbay
- NPO HIPEC Istanbul, Guzelbahce Sokak No:15 Nisantasi, Istanbul 34367, Turkey.
| | - Yang Liu
- Peritoneal Surface Malignancy Center, Kishiwada Tokushukai Hospital, 4-27-1 Kamori-Cho, Kishiwada City, Osaka 596-8522, Japan.
| | - Haruaki Ishibashi
- NPO Organization to support Peritoneal Surface Malignancy Treatment, 510 Fukushima-Cho, Shimogyou-Ku, Kyoto 600-8189, Japan
| | - Akiyoshi Mizumoto
- Department of General Surgery, Kusatsu General Hospital, 1660 Yabase, Kusatsu City, Shiga 525-8585, Japan.
| | - Masamitu Hirano
- Department of General Surgery, Kusatsu General Hospital, 1660 Yabase, Kusatsu City, Shiga 525-8585, Japan.
| | - Yuuki Imazato
- Department of General Surgery, Kusatsu General Hospital, 1660 Yabase, Kusatsu City, Shiga 525-8585, Japan.
| | - Nobuyuki Takao
- Department of General Surgery, Kusatsu General Hospital, 1660 Yabase, Kusatsu City, Shiga 525-8585, Japan.
| | - Masumi Ichinose
- Department of General Surgery, Kusatsu General Hospital, 1660 Yabase, Kusatsu City, Shiga 525-8585, Japan.
| | - Kousuke Noguchi
- Department of General Surgery, Kusatsu General Hospital, 1660 Yabase, Kusatsu City, Shiga 525-8585, Japan.
| | - Yan Li
- Department of Peritoneal Surface Oncology, Beijing Shijitan Hospital of Capital Medical University, Beijing 100038, China.
| | - Satoshi Wakama
- Peritoneal Surface Malignancy Center, Kishiwada Tokushukai Hospital, 4-27-1 Kamori-Cho, Kishiwada City, Osaka 596-8522, Japan.
| | - Kazuhiro Yamada
- Peritoneal Surface Malignancy Center, Kishiwada Tokushukai Hospital, 4-27-1 Kamori-Cho, Kishiwada City, Osaka 596-8522, Japan.
| | - Koutarou Hatano
- Peritoneal Surface Malignancy Center, Kishiwada Tokushukai Hospital, 4-27-1 Kamori-Cho, Kishiwada City, Osaka 596-8522, Japan.
| | - Hiroshi Shintani
- Peritoneal Surface Malignancy Center, Kishiwada Tokushukai Hospital, 4-27-1 Kamori-Cho, Kishiwada City, Osaka 596-8522, Japan.
| | - Hiroyuki Yoshitake
- Peritoneal Surface Malignancy Center, Kishiwada Tokushukai Hospital, 4-27-1 Kamori-Cho, Kishiwada City, Osaka 596-8522, Japan.
| | - Shun-Ichiro Ogura
- Graduate School of Bioscience and Biotechnology, Tokyo Institute of Technology, 4259 Nagatsu-Cho, Midori-ku, Yokohama 226-8501, Japan.
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