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Lopez-Ramirez F, Gushchin V, Sittig M, King MC, Baron E, Nikiforchin A, Nieroda C, Sardi A. Iterative Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy for Recurrent Mucinous Adenocarcinoma of the Appendix. Ann Surg Oncol 2022; 29:3390-3401. [PMID: 35133518 DOI: 10.1245/s10434-021-11233-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 11/04/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Recurrence after cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) for appendiceal tumors (AT) with mucinous carcinomatosis peritonei (MCP) is common. The evidence favoring iterative procedures (iCRS/HIPEC) is limited, and its benefit is not clear for all patients. METHODS Retrospective (1998-2020) cohorts of AT patients with MCP recurrence after the first CRS/HIPEC were analyzed. Outcomes were compared within tumor grades between iCRS/HIPEC patients and matched control patients without iCRS/HIPEC using propensity score matching (1:1). Post-recurrence survival (PRS) was measured from the date of recurrence after the first CRS/HIPEC to death or last contact. RESULTS Overall, 55 iCRS/HIPEC patients were identified: 36 low-grade (LGMCP) patients, 13 high-grade (HGMCP) patients, and 6 HGMCP patients with signet-ring features (HGMCP-S). Nine patients had a third CRS/HIPEC. The median peritoneal cancer index (PCI) scores were 33, 19 and 10, with CC-0/1 achieved for 94.4%, 78.2% and 88.9% of the patients after the first, second, and third CRS/HIPEC, respectively. No 90-day postoperative mortality occurred. The median progression-free survival from the first CRS/HIPEC was 19.7 months for the iCRS/HIPEC patients versus 14.2 months for the matched control patients (p = 0.43). The median PRS was 80.2 months for iCRS/HIPEC versus 36.2 for the control patients (p < 0.001). For the iCRS/HIPEC versus the matched control patients, the median PRS by tumor grade was 174.1 versus 51.9 (p < 0.001) for the LGMCP, 42.0 versus 12.4 (p = 0.02) for the HGMCP, and 15.4 versus 8.1 months (p = 0.61) for the HGMCP-S patients, respectively. CONCLUSIONS Selected low- and high-grade appendiceal cancer patients with MCP recurrence able to undergo iterative CRS/HIPEC procedures showed favorable outcomes and such patients should be considered for surgery when feasible. This survival benefit with iCRS/HIPEC is not evidenced in recurrent MCP with signet ring cell morphology.
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Affiliation(s)
- Felipe Lopez-Ramirez
- Department of Surgical Oncology, Mercy Medical Center, The Institute for Cancer Care, Baltimore, MD, USA
| | - Vadim Gushchin
- Department of Surgical Oncology, Mercy Medical Center, The Institute for Cancer Care, Baltimore, MD, USA
| | - Michelle Sittig
- Department of Surgical Oncology, Mercy Medical Center, The Institute for Cancer Care, Baltimore, MD, USA
| | - Mary Caitlin King
- Department of Surgical Oncology, Mercy Medical Center, The Institute for Cancer Care, Baltimore, MD, USA
| | - Ekaterina Baron
- Department of Surgical Oncology, Mercy Medical Center, The Institute for Cancer Care, Baltimore, MD, USA
| | - Andrei Nikiforchin
- Department of Surgical Oncology, Mercy Medical Center, The Institute for Cancer Care, Baltimore, MD, USA
| | - Carol Nieroda
- Department of Surgical Oncology, Mercy Medical Center, The Institute for Cancer Care, Baltimore, MD, USA
| | - Armando Sardi
- Department of Surgical Oncology, Mercy Medical Center, The Institute for Cancer Care, Baltimore, MD, USA.
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Lopez-Ramirez F, Gushchin V, Sittig M, King MC, Baron E, Nikiforchin A, Nieroda C, Sardi A. ASO Visual Abstract: Iterative Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy for Recurrent Mucinous Adenocarcinoma of the Appendix. Ann Surg Oncol 2022. [DOI: 10.1245/s10434-021-11257-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Perez-Bustos AH, Orozco-Urdaneta M, Erazo R, Cordoba-Astudillo P, Gallo D, Muñoz-Zuluaga C, Sittig M, Sardi A. A patient navigation initiative to improve access to breast cancer care in Cali, Colombia. Cancer Rep (Hoboken) 2021; 5:e1564. [PMID: 34725973 PMCID: PMC9458495 DOI: 10.1002/cnr2.1564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Patient navigation is the logistical and emotional support necessary to achieve diagnostic and treatment compliance. It can improve time to diagnosis, initiation of treatment, and patient satisfaction, as well as reduce the cost of treatment. Colombia has a well-defined Cancer Control Plan, but its implementation is lacking. AIM To implement the first patient navigation initiative in Colombia, as part of a pilot program for the early detection of breast cancer. METHODS The process involved assessing and addressing the barriers faced by women to access breast health care by providing training for health personnel, strengthening primary health care providers, and coordinating diverse level institutions for the provision of services. This led to the design and implementation of a navigation strategy focused on the needs of patients in Cali, Colombia and the involvement of the local health system to provide such services. RESULTS Time to diagnosis was significantly reduced; research advanced by the Colombian National Institute of Cancerology shows that the average time between the first medical consultation and diagnosis was 91 days (CI 95%: 82-97 days), while this study carried out the same process in an average of 30 days, but patients still had issues with continuity of treatment due to financial strain between healthcare providers and insurers. Navigation, however, manages to overcome many of these problems by assisting women in the clinical and administrative care processes and seeking well-being for the beneficiaries. In addition, patient navigation helped identify critical failures in care, such as fragmentation of care and excessive bureaucracy. The navigation process improved data collection and established agreements to simplify and make the delivery of care more efficient. In addition, it generated partnerships between service providers and insurers. CONCLUSION While several barriers and poor understanding of the navigation process still exist, a navigation program can help implement a Cancer Control Plan.
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Affiliation(s)
| | - Mavalynne Orozco-Urdaneta
- Fundación para la Prevención y Tratamiento del Cáncer, Cali, Colombia.,Partners for Cancer Care and Prevention, Baltimore, Maryland, USA
| | - Raúl Erazo
- Fundación para la Prevención y Tratamiento del Cáncer, Cali, Colombia
| | | | - David Gallo
- Fundación para la Prevención y Tratamiento del Cáncer, Cali, Colombia
| | - Carlos Muñoz-Zuluaga
- Partners for Cancer Care and Prevention, Baltimore, Maryland, USA.,The Institute for Cancer Care, Mercy Medical Center, Baltimore, Maryland, USA
| | - Michelle Sittig
- The Institute for Cancer Care, Mercy Medical Center, Baltimore, Maryland, USA
| | - Armando Sardi
- Fundación para la Prevención y Tratamiento del Cáncer, Cali, Colombia.,Partners for Cancer Care and Prevention, Baltimore, Maryland, USA.,The Institute for Cancer Care, Mercy Medical Center, Baltimore, Maryland, USA
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Nikiforchin A, Gushchin V, Sittig M, Baron E, Lopez-Ramirez F, Nieroda C, Sardi A. Outcomes Following Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy with and without Diaphragmatic Resection in Patients with Peritoneal Metastases. Ann Surg Oncol 2021; 29:873-882. [PMID: 34546479 DOI: 10.1245/s10434-021-10669-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 08/01/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Diaphragmatic resection (DR) is often required during cytoreductive surgery/hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) to achieve complete cytoreduction (CC). While CC provides the best survival, requiring a DR may indicate unfavorable tumor biology. We assessed how DR during CRS/HIPEC affects outcomes. METHODS A retrospective cohort study was conducted using a prospective single-center database from October 1994-May 2020. Peritoneal surface malignancy patients who underwent CRS/HIPEC with CC-0/1/2 were assigned to DR and NoDR groups. Survival was measured using the Kaplan-Meier method. Subgroup analysis was performed for patients with peritoneal cancer index (PCI) ≥ 20 to eliminate confounding of more extensive disease in DR. RESULTS Of 824 CRS/HIPECs, 774 were included: 134 DR and 640 NoDR. PCI was significantly higher in DR: 29 versus 21, p < 0.001. CC-0/1 rate was 89% in DR and 95% in NoDR (p = 0.003). Neither 100-day morbidity nor mortality differed between the groups (p = 0.355 and p = 1.000). Median follow-up was 64 months. Median overall survival (OS) was significantly lower in DR (32 vs. 96 months, p < 0.001). Subgroup analysis by tumor type in patients with PCI ≥ 20 showed significantly shorter OS in DR than NoDR in appendiceal (40 vs. 196 months, p < 0.001) and colorectal (14 vs. 23 months, p = 0.003), but not in ovarian tumors (32 vs. 42 months, p = 0.893), whereas median PCI did not differ among subgroups. CONCLUSIONS DR during CRS/HIPEC does not increase morbidity and mortality. It is associated with worse survival in appendiceal and colorectal tumors, even after adjusting for tumor burden but does not appear to impact ovarian cancer survival.
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Affiliation(s)
- Andrei Nikiforchin
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 Saint Paul Place, Baltimore, MD, 21202, USA
| | - Vadim Gushchin
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 Saint Paul Place, Baltimore, MD, 21202, USA
| | - Michelle Sittig
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 Saint Paul Place, Baltimore, MD, 21202, USA
| | - Ekaterina Baron
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 Saint Paul Place, Baltimore, MD, 21202, USA
| | - Felipe Lopez-Ramirez
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 Saint Paul Place, Baltimore, MD, 21202, USA
| | - Carol Nieroda
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 Saint Paul Place, Baltimore, MD, 21202, USA
| | - Armando Sardi
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 Saint Paul Place, Baltimore, MD, 21202, USA.
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Nikiforchin A, Sittig M, Gushchin V, Sardi A. ASO Author Reflections: What to Expect After You Resect Diaphragm During CRS/HIPEC. Ann Surg Oncol 2021; 29:883-884. [PMID: 34537898 DOI: 10.1245/s10434-021-10824-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/04/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Andrei Nikiforchin
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
| | - Michelle Sittig
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
| | - Vadim Gushchin
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
| | - Armando Sardi
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA.
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Nikiforchin A, Gushchin V, Sittig M, Baron E, Lopez-Ramirez F, Nieroda C, Sardi A. ASO Visual Abstract: Outcomes Following Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy With and Without Diaphragmatic Resection in Patients with Peritoneal Metastases. Ann Surg Oncol 2021. [PMID: 34529171 DOI: 10.1245/s10434-021-10740-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Andrei Nikiforchin
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 St. Paul Place, 4th Floor Weinberg, Baltimore, MD, 21202-2001, USA
| | - Vadim Gushchin
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 St. Paul Place, 4th Floor Weinberg, Baltimore, MD, 21202-2001, USA
| | - Michelle Sittig
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 St. Paul Place, 4th Floor Weinberg, Baltimore, MD, 21202-2001, USA
| | - Ekaterina Baron
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 St. Paul Place, 4th Floor Weinberg, Baltimore, MD, 21202-2001, USA
| | - Felipe Lopez-Ramirez
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 St. Paul Place, 4th Floor Weinberg, Baltimore, MD, 21202-2001, USA
| | - Carol Nieroda
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 St. Paul Place, 4th Floor Weinberg, Baltimore, MD, 21202-2001, USA
| | - Armando Sardi
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 St. Paul Place, 4th Floor Weinberg, Baltimore, MD, 21202-2001, USA.
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Bhatt A, Rousset P, Baratti D, Biacchi D, Benzerdjeb N, H J T de Hingh I, Deraco M, Gushchin V, Kammar P, Labow D, Levine E, Moran B, Mohamed F, Morris D, Mehta S, Nissan A, Alyami M, Adileh M, Barat S, Ben Yacov A, Campbell K, Cummins-Perry K, Cortes-Guiral D, Cohen N, Parikh L, Alammari S, Bashanfer G, Alshukami A, Kundalia K, Goswami G, de Vlasakker VV, Sittig M, Sammartino P, Sardi A, Villeneuve L, Turaga K, Yonemura Y, Glehen O. Patterns of peritoneal dissemination and response to systemic chemotherapy in common and rare peritoneal tumours treated by cytoreductive surgery: study protocol of a prospective, multicentre, observational study. BMJ Open 2021; 11:e046819. [PMID: 34226220 PMCID: PMC8258594 DOI: 10.1136/bmjopen-2020-046819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 06/18/2021] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Despite optimal patient selection and surgical effort, recurrence is seen in over 70% of patients undergoing cytoreductive surgery (CRS) for peritoneal metastases (PM). Apart from the Peritoneal Cancer Index (PCI), completeness of cytoreduction and tumour grade, there are other factors like disease distribution in the peritoneal cavity, pathological response to systemic chemotherapy (SC), lymph node metastases and morphology of PM which may have prognostic value. One reason for the underutilisation of these factors is that they are known only after surgery. Identifying clinical predictors, specifically radiological predictors, could lead to better utilisation of these factors in clinical decision making and the extent of peritoneal resection performed for different tumours. This study aims to study these factors, their impact on survival and identify clinical and radiological predictors. METHODS AND ANALYSIS There is no therapeutic intervention in the study. All patients with biopsy-proven PM from colorectal, appendiceal, gastric and ovarian cancer and peritoneal mesothelioma undergoing CRS will be included. The demographic, clinical, radiological, surgical and pathological details will be collected according to a prespecified format that includes details regarding distribution of disease, morphology of PM, regional node involvement and pathological response to SC. In addition to the absolute value of PCI, the structures bearing the largest tumour nodules and a description of the morphology in each region will be recorded. A correlation between the surgical, radiological and pathological findings will be performed and the impact of these potential prognostic factors on progression-free and overall survival determined. The practices pertaining to radiological and pathological reporting at different centres will be studied. ETHICS AND DISSEMINATION The study protocol has been approved by the Zydus Hospital ethics committee (27 July, 2020) and Lyon-Sud ethics committee (A15-128). TRIAL REGISTRATION NUMBER CTRI/2020/09/027709; Pre-results.
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Affiliation(s)
- Aditi Bhatt
- Surgical Oncology, Zydus Hospital, Ahmedabad, India
| | - Pascal Rousset
- Radiology, Centre Hospitalier Lyon-Sud, Pierre-Benite, France
| | - Dario Baratti
- Surgical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | | | | | - Marcello Deraco
- Surgical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Vadim Gushchin
- Surgical Oncology, Mercy Medical Center, Baltimore, Maryland, USA
| | | | - Daniel Labow
- Surgical Oncology, Mount Sinai Medical Center, New York City, New York, USA
| | - Edward Levine
- Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Brendan Moran
- Peritoneal malignancy unit, Basingstoke and North Hampshire NHS Foundation Trust, Basingstoke, UK
| | - Faheez Mohamed
- Peritoneal malignancy unit, Basingstoke and North Hampshire NHS Foundation Trust, Winchester, UK
| | - David Morris
- Peritonectomy Unit, University of New South Wales, Sydney, New South Wales, Australia
| | - Sanket Mehta
- Surgical Oncology, Saifee Hospital, Mumbai, India
| | - Aviram Nissan
- Surgical Oncology, Sheba Medical Center, Tel Hashomer, Israel
| | - Mohammad Alyami
- Surgical Oncology, King Khaled Hospital, Najran, Saudi Arabia
| | - Mohammad Adileh
- Surgical Oncology, Sheba Medical Center, Tel Hashomer, Israel
| | - Shoma Barat
- Surgical Oncology, St. George Hospital, Sydney, New South Wales, Australia
| | - Almog Ben Yacov
- Surgical Oncology, Sheba Medical Center, Tel Hashomer, Israel
| | - Kurtis Campbell
- Surgical Oncology, Mercy Medical Center, Baltimore, Maryland, USA
| | | | | | - Noah Cohen
- Surgical Oncology, Mount Sinai Medical Center, New York City, New York, USA
| | | | - Samer Alammari
- Surgical Oncology, King Khaled Hospital, Najran, Saudi Arabia
| | | | | | - Kaushal Kundalia
- Surgical Oncology, Basingstoke and North Hampshire NHS Foundation Trust, Winchester, UK
| | | | | | - Michelle Sittig
- Surgical Oncology, Mercy Medical Center, Baltimore, Maryland, USA
| | | | - Armando Sardi
- Surgical Oncology, Mercy Medical Center, Baltimore, Maryland, USA
| | | | - Kiran Turaga
- Surgical Oncology, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Yutaka Yonemura
- Surgical Oncology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Olivier Glehen
- Surgical Oncology, Centre Hospitalier Lyon-Sud, Pierre-Benite, France
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Baron E, Sardi A, King M, Nikiforchin A, Lopez-Ramirez F, Sittig M, Gushchin V, Ledakis P. P-118 Survival outcomes of adjuvant chemotherapy in stage IVA/B high-grade appendiceal cancer treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Baron E, Velez-Mejia C, Sittig M, Spiliotis J, Nikiforchin A, Lopez-Ramirez F, Gushchin V, Sardi A. Delayed genital necrosis after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy with Mitomycin-C. Eur J Surg Oncol 2021; 47:2352-2357. [PMID: 33933342 DOI: 10.1016/j.ejso.2021.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/08/2021] [Accepted: 04/05/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Genital necrosis (GN) is a rare complication of cytoreductive surgery with hyperthermic intraoperative chemotherapy (CRS/HIPEC) which can be confused with necrotizing fasciitis. We present an analysis of GN after CRS/HIPEC to define its natural history. METHODS We identified patients with GN after CRS/HIPEC at two peritoneal surface malignancy institutions. Patient demographic, surgical, and postoperative data were extracted from prospective databases. RESULTS Of 1597 CRS/HIPECs performed, 13 patients (0.8%) had GN. The median age was 57 years (IQR: 49-64) and 77% (n = 10) were male. Mitomycin-C was the perfusion agent in all cases of GN (100%). The median time to GN onset after CRS/HIPEC was 64 days (IQR: 60-108) and 2 (15%) patients were receiving systemic chemotherapy at the time of GN onset. Symptoms included severe pain (100%), edema (100%), labial or scrotal skin ulceration (92%), signs of infection (39%), and fever (15%). Seven (54%) patients had thrombocytosis >400 ∗109/L, whereas coagulation tests were within normal reference range in 100% cases. All patients initially underwent conservative treatment, with antibiotic therapy administered in 62% (n = 8). Surgical debridement was performed in 9 (70%) cases with median time after GN onset of 57 (IQR: 8-180). CONCLUSION GN is a debilitating complication after CRS/HIPEC with delayed onset and a protracted clinical course. Optimal treatment results could be achieved with initial conservative management until complete lesion demarcation followed by surgical debridement. The pathophysiology of GN is unclear, and we call for other researchers attention to better understand the complication and prevention.
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Affiliation(s)
- Ekaterina Baron
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center 227 St. Paul Place, 4th Floor Weinberg, Baltimore, MD, 21202-2001, USA
| | - Carolina Velez-Mejia
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center 227 St. Paul Place, 4th Floor Weinberg, Baltimore, MD, 21202-2001, USA; University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA
| | - Michelle Sittig
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center 227 St. Paul Place, 4th Floor Weinberg, Baltimore, MD, 21202-2001, USA
| | - John Spiliotis
- European Interbalkan Medical Center, Asklipiou 10, Pilea 555 35m, Thessaloniki, Greece; Athens Medical Center, Distomou 5-7, Athens, 151 25, Greece
| | - Andrei Nikiforchin
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center 227 St. Paul Place, 4th Floor Weinberg, Baltimore, MD, 21202-2001, USA
| | - Felipe Lopez-Ramirez
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center 227 St. Paul Place, 4th Floor Weinberg, Baltimore, MD, 21202-2001, USA
| | - Vadim Gushchin
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center 227 St. Paul Place, 4th Floor Weinberg, Baltimore, MD, 21202-2001, USA
| | - Armando Sardi
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center 227 St. Paul Place, 4th Floor Weinberg, Baltimore, MD, 21202-2001, USA.
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Baron E, Sittig M, Kotov M, Fomintsev I, Gushchin V. Educational Collaboration Between Russian-Born US Physicians and Russian Oncology Trainees in Evidence-Based Medicine: The Higher School of Oncology. JCO Glob Oncol 2021; 7:353-360. [PMID: 33667114 PMCID: PMC8081499 DOI: 10.1200/go.20.00546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The 2-year Russian oncology residency focuses on diagnosis and treatment of malignancies but lacks evidence-based medicine (EBM) and patient communication skills (PCS) training. To overcome these educational disparities, the 5-year national program, the Higher School of Oncology (HSO), involving Russian expatriate physicians trained in the United States was established. METHODS A retrospective study was conducted. Highly motivated oncology residents were enrolled in the program through the three-step selection process. US-trained Russian expatriate physicians acted as mentors. EBM skills were taught through weekly online journal clubs and clinical case presentations. PCS training included live seminars and simulations after journal clubs. EBM knowledge was assessed using Fresno test among newly enrolled and postgraduate year (PGY) 2-5 HSO residents. PCS were evaluated via simulation exam including two clinical scenarios (maximum score 100 each) among 17 PGY2 HSO residents and seven non-HSO trainees. RESULTS Overall, 54 residents were enrolled over 5 years (8-13 annually); four were released from the program. The mean age was 24 ± 1 years, and 56% were females. Median scores of Fresno test were significantly higher among PGY 2-4 HSO residents compared with newly enrolled participants: 111 (IQR, 71-128) versus 68 (IQR, 42-84), P = .042; moreover, performance correlated with year of program participation (rs = 0.5; P < .0001). PCS assessment score was significantly higher among HSO residents than non-HSO trainees: 71 (IQR, 58-84) versus 15 (IQR, 10-30) for scenario number 1 (P < .0001) and 78 (IQR, 71-85) versus 22 (IQR, 4-58) for scenario number 2 (P = .005), respectively. CONCLUSION The involvement of Western-trained expatriates in remote education improves EBM and PCS among oncology trainees from their home country. This strategy can be useful in overcoming global medical education disparities in other specialties and in countries facing similar challenges.
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Affiliation(s)
- Ekaterina Baron
- Department of Surgical Oncology, Mercy Medical Center, The Institute for Cancer Care at Mercy, Baltimore, MD
| | - Michelle Sittig
- Department of Surgical Oncology, Mercy Medical Center, The Institute for Cancer Care at Mercy, Baltimore, MD
| | - Maxim Kotov
- Department of Head and Neck Cancer, N.N. Petrov National Medical Research Center of Oncology, St Petersburg, Russia
| | | | - Vadim Gushchin
- Department of Surgical Oncology, Mercy Medical Center, The Institute for Cancer Care at Mercy, Baltimore, MD
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Nikiforchin A, Gushchin V, King MC, Baron E, Nieroda C, Sittig M, Sardi A. Surgical and oncological outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy at a nonacademic center: 25-year experience. J Surg Oncol 2021; 123:1030-1044. [PMID: 33524164 DOI: 10.1002/jso.26371] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/19/2020] [Accepted: 12/28/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is predominantly performed and studied in academic centers. While developing CRS/HIPEC programs in nonacademic hospitals can increase accessibility, its safety and oncological efficacy remains unclear. We evaluated CRS/HIPEC outcomes in a nonacademic setting. METHODS A single-center descriptive study was conducted using a prospective database. Data of all CRS/HIPEC attempts in peritoneal surface malignancies (PSM) patients from October 1994 to November 2019 were extracted. Surgical and survival outcomes were measured. Center experience was assessed by quartiles of cases. RESULTS Overall, 856 patients underwent 948 CRS/HIPEC attempts: 788 (83%) completed CRS/HIPECs, 144 (15%) aborted HIPECs, and 16 (2%) complete cytoreductions (CC-0/1) without chemoperfusion. For completed CRS/HIPECs, median peritoneal cancer index was 24 (interquartile range: 10-33) and CC-0/1 rate was 88%. Major complications occurred in 23.5% with 30- and 100-day mortality of 1.0% and 2.3%, respectively. Median overall survival was 68 months (95% confidence interval [CI]: 50-86). Median progression-free survival was 37 months (95%CI: 28-46). Incomplete cytoreduction and major complication rates decreased over time, while mortality remained low and constant. CONCLUSIONS CRS/HIPEC at a nonacademic center with advanced surgical and auxiliary services is a safe option to treat PSM with favorable surgical and oncological outcomes.
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Affiliation(s)
- Andrei Nikiforchin
- Department of Surgical Oncology, Mercy Medical Center, The Institute for Cancer Care at Mercy, Baltimore, Maryland, USA
| | - Vadim Gushchin
- Department of Surgical Oncology, Mercy Medical Center, The Institute for Cancer Care at Mercy, Baltimore, Maryland, USA
| | - Mary Caitlin King
- Department of Surgical Oncology, Mercy Medical Center, The Institute for Cancer Care at Mercy, Baltimore, Maryland, USA
| | - Ekaterina Baron
- Department of Surgical Oncology, Mercy Medical Center, The Institute for Cancer Care at Mercy, Baltimore, Maryland, USA
| | - Carol Nieroda
- Department of Surgical Oncology, Mercy Medical Center, The Institute for Cancer Care at Mercy, Baltimore, Maryland, USA
| | - Michelle Sittig
- Department of Surgical Oncology, Mercy Medical Center, The Institute for Cancer Care at Mercy, Baltimore, Maryland, USA
| | - Armando Sardi
- Department of Surgical Oncology, Mercy Medical Center, The Institute for Cancer Care at Mercy, Baltimore, Maryland, USA
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Zambrano-Vera K, Sardi A, Sittig M, Diaz-Montes T. ASO Author Reflections: The Frailty of Patient Selection. Ann Surg Oncol 2021; 28:4667. [PMID: 33398643 DOI: 10.1245/s10434-020-09473-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Katherin Zambrano-Vera
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
| | - Armando Sardi
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA.
| | - Michelle Sittig
- Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
| | - Teresa Diaz-Montes
- Department of Gynecologic Oncology, Ovarian Cancer Institute, Mercy Medical Center, Baltimore, MD, USA
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13
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Zambrano-Vera K, Sardi A, Lopez-Ramirez F, Sittig M, Munoz-Zuluaga C, Nieroda C, Gushchin V, Diaz-Montes T. Outcomes for Elderly Ovarian Cancer Patients Treated with Cytoreductive Surgery Plus Hyperthermic Intraperitoneal Chemotherapy (CRS/HIPEC). Ann Surg Oncol 2021; 28:4655-4666. [PMID: 33393042 DOI: 10.1245/s10434-020-09415-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 11/12/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Women 65 years of age or older with epithelial ovarian cancer (EOC) are thought to have a worse prognosis than younger patients. However, no consensus exists concerning the best treatment for ovarian cancer in this age group. This report presents outcomes for patients treated with cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC). METHODS A prospective database of EOC patients treated with CRS/HIPEC (1998-2019) was analyzed. Perioperative variables were compared by treatment including upfront CRS/HIPEC, neoadjuvant chemotherapy plus CRS/HIPEC (NACT + CRS/HIPEC), and salvage CRS/HIPEC, and by age at surgery (< 65 and ≥ 65 years). Survival analysis was performed, and outcomes were compared. RESULTS Of the 148 patients identified, 42 received upfront CRS/HIPEC, 48 received NACT + CRS/HIPEC, and 58 received salvage CRS/HIPEC. Each group was subdivided by age groups (< 65 and ≥ 65 years). The median overall survival (OS) after the upfront CRS/HIPEC was 69.2 months for the patients < 65 years of age versus 69.3 months for those ≥ 65 years of age. The OS after NACT + CRS/HIPEC was 26.9 months for the patients < 65 years of age versus 32.9 months for those ≥ 65 years of age, and the OS after salvage CRS/HIPEC was 45.6 months for the patients < 65 years of age versus 23.9 months for those ≥ 65 years of age. The median progression-free survival (PFS) after upfront CRS/HIPEC was 41.3 months for the patients < 65 years of age versus 45.4 months for those ≥ 65 years of age. The PFS after NACT + CRS/HIPEC was 16.2 months for the patients < 65 years of age versus 11.2 months for those ≥ 65 years of age, and the PFS after salvage CRS/HIPEC was 18.7 months for the patients < 65 years of age versus 10 months for those ≥ 65 years of age. The median follow-up period for the entire cohort was 44.6 months [95% confidence interval (CI) 34.7-60.6 months]. CONCLUSION Age and feasibility of complete cytoreduction should be considered when treatment methods are selected for elderly patients. A carefully selected elderly population can benefit significantly from aggressive treatment methods.
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Affiliation(s)
- Katherin Zambrano-Vera
- Department of Surgical Oncology, Mercy Medical Center, The Institute for Cancer Care at Mercy, Baltimore, MD, USA
| | - Armando Sardi
- Department of Surgical Oncology, Mercy Medical Center, The Institute for Cancer Care at Mercy, Baltimore, MD, USA.
| | - Felipe Lopez-Ramirez
- Department of Surgical Oncology, Mercy Medical Center, The Institute for Cancer Care at Mercy, Baltimore, MD, USA
| | - Michelle Sittig
- Department of Surgical Oncology, Mercy Medical Center, The Institute for Cancer Care at Mercy, Baltimore, MD, USA
| | - Carlos Munoz-Zuluaga
- Department of Surgical Oncology, Mercy Medical Center, The Institute for Cancer Care at Mercy, Baltimore, MD, USA
| | - Carol Nieroda
- Department of Surgical Oncology, Mercy Medical Center, The Institute for Cancer Care at Mercy, Baltimore, MD, USA
| | - Vadim Gushchin
- Department of Surgical Oncology, Mercy Medical Center, The Institute for Cancer Care at Mercy, Baltimore, MD, USA
| | - Teresa Diaz-Montes
- Department of Surgical Oncology, Mercy Medical Center, The Institute for Cancer Care at Mercy, Baltimore, MD, USA
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14
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King MC, Munoz‐Zuluaga C, Ledakis P, Studeman K, Sittig M, Gushchin V, Sardi A. Germline and somatic genetic alterations in two first-degree relatives with appendiceal low-grade mucinous carcinoma peritonei. Clin Case Rep 2020; 8:3168-3177. [PMID: 33363901 PMCID: PMC7752445 DOI: 10.1002/ccr3.3338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/21/2020] [Accepted: 08/12/2020] [Indexed: 11/06/2022] Open
Abstract
Comparing genetic mutations of first-degree relatives with appendiceal pseudomyxoma peritonei may explain clinical outcomes and disease pathogenesis. Molecular profiling of mucinous tumors may identify improved treatments to traditional chemotherapy.
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Affiliation(s)
| | | | | | | | - Michelle Sittig
- The Institute for Cancer CareMercy Medical CenterBaltimoreMDUSA
| | - Vadim Gushchin
- The Institute for Cancer CareMercy Medical CenterBaltimoreMDUSA
| | - Armando Sardi
- The Institute for Cancer CareMercy Medical CenterBaltimoreMDUSA
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15
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Munoz-Zuluaga CA, King MC, Diaz-Sarmiento VS, Studeman K, Sittig M, MacDonald R, Nieroda C, Zambrano-Vera K, Gushchin V, Sardi A. Defining "Complete Cytoreduction" After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS/HIPEC) for the Histopathologic Spectrum of Appendiceal Carcinomatosis. Ann Surg Oncol 2020; 27:5026-5036. [PMID: 32705513 DOI: 10.1245/s10434-020-08844-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 06/27/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND The completeness of cytoreduction (CC) score, which quantifies residual tumor, is a major prognostic factor when treating appendiceal carcinomatosis with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). Both CC-0 and CC-1 are considered complete cytoreductions (CC-0/1) and associated with the best outcomes. We analyzed if the CC-0/1 definition is reliable across appendiceal histopathologic subtypes. METHODS A prospective database of CRS/HIPEC patients with appendiceal carcinomatosis from 1998 to 2019 was reviewed to identify patients with CC-0/1. Kaplan-Meier overall survival (OS) and progression-free survival (PFS) by CC-score for each histopathology were calculated. RESULTS Overall, 297 patients had CC-0/1. Mean age was 54 ± 12 years with 67% females. Histopathologic subtypes were 45% low-grade mucinous carcinoma peritonei (LGMCP), 27% high-grade MCP (HGMCP), 20% HGMCP with signet ring cells (HGMCP-S), and 8% goblet cell adenocarcinoma (GCAC). CC-0 and CC-1 occurred in 57% and 43% of LGMCP, 65% and 35% of HGMCP, 68% and 32% of HGMCP-S, and 79% and 21% of GCAC, respectively. OS and PFS were statistically longer for CC-0 versus CC-1 in HGMCP-S (p = 0.001 and p = 0.005, respectively) and GCAC (p < 0.001 and p < 0.001), but not in LGMCP (p = 0.098 and p = 0.398) or HGMCP (p = 0.167 and p = 0.356). CONCLUSIONS Survival outcomes for CC-0 and CC-1 after CRS/HIPEC are different for HGMCP-S and GCAC but not for LGMCP and HGMCP. In HGCMP-S and GCAC, only CC-0 should be considered a complete cytoreduction and analyzed separately from CC-1. This distinction is key to understand disease behavior, accurately address patient prognosis, and explore new treatment strategies.
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Affiliation(s)
| | - Mary C King
- The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
| | | | - Kimberley Studeman
- The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA.,Department of Pathology, Mercy Medical Center, Baltimore, MD, USA
| | - Michelle Sittig
- The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
| | - Ryan MacDonald
- Department of Pathology, Mercy Medical Center, Baltimore, MD, USA
| | - Carol Nieroda
- The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
| | | | - Vadim Gushchin
- The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
| | - Armando Sardi
- The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA.
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16
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Henningsgaard M, Sittig M, Velez-Mejia C, Sardi A. Pyoderma Gangrenosum in a Patient with Advanced Rectal Cancer Treated with Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy. Am Surg 2020. [DOI: 10.1177/000313481908501122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Mary Henningsgaard
- Department of Surgical Oncology Mercy Medical Center Baltimore, Maryland
| | - Michelle Sittig
- Department of Surgical Oncology Mercy Medical Center Baltimore, Maryland
| | | | - Armando Sardi
- Department of Surgical Oncology Mercy Medical Center Baltimore, Maryland
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17
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Sardi A, Orozco-Urdaneta M, Velez-Mejia C, Perez-Bustos AH, Munoz-Zuluaga C, El-Sharkawy F, Parra-Lara LG, Córdoba P, Gallo D, Sittig M, King MC, Nieroda C, Zambrano-Vera K, Singer J. Overcoming Barriers in the Implementation of Programs for Breast and Cervical Cancers in Cali, Colombia: A Pilot Model. J Glob Oncol 2020; 5:1-9. [PMID: 31260395 PMCID: PMC6613667 DOI: 10.1200/jgo.19.00054] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Breast and cervical cancers are leading causes of mortality among women in Latin America. Colombia has universal health care and a government-sponsored 10-year cancer control plan focused on prevention, early detection, and treatment. However, many administrative and social barriers have hindered its success, and a majority of patients are diagnosed at a late stage. Established in 2012, Partners for Cancer Care and Prevention (PFCCAP) works to decrease the burden of these cancers by mitigating the obstacles women face during their cancer diagnosis and treatment. Through community outreach meetings with medical personnel, hospital directors, and government officials, PFCCAP identified major barriers, including lack of trained health care personnel, few centers with adequate screening equipment, and a fragmented health system with significant administrative delays and poor continuity of care. Its solution included monthly teleconferences, biannual on-site training, quality control programs, and improved access to screening equipment. PFCCAP also initiated a patient navigation project. After implementation of the PFCCAP plan of action, from 2012 to 2018, the average time from initial consult to biopsy decreased from 65 to 20 days; from biopsy to diagnosis, 33 to 4 days; and from diagnosis to surgery, 121 to 60 days. To date, more than 1,500 women have benefited from this initiative, which has expanded to other regions. Overall, PFCCAP is creating centers of excellence in strategically located hospitals and promoting the implementation of national guidelines. Although several barriers still exist, PFCCAP is helping to implement an efficient health care model that can be replicated in other underserved populations.
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Affiliation(s)
- Armando Sardi
- Institute for Cancer Care, Mercy Medical Center, Baltimore, MD.,Fundación para la Prevención y Tratamiento del Cáncer, Cali, Colombia
| | - Mavalynne Orozco-Urdaneta
- Partners for Cancer Care and Prevention, Baltimore, MD.,Fundación para la Prevención y Tratamiento del Cáncer, Cali, Colombia
| | - Carolina Velez-Mejia
- Institute for Cancer Care, Mercy Medical Center, Baltimore, MD.,Fundación para la Prevención y Tratamiento del Cáncer, Cali, Colombia
| | | | - Carlos Munoz-Zuluaga
- Institute for Cancer Care, Mercy Medical Center, Baltimore, MD.,Fundación para la Prevención y Tratamiento del Cáncer, Cali, Colombia
| | - Farah El-Sharkawy
- Partners for Cancer Care and Prevention, Baltimore, MD.,Fundación para la Prevención y Tratamiento del Cáncer, Cali, Colombia
| | | | - Patricia Córdoba
- Fundación para la Prevención y Tratamiento del Cáncer, Cali, Colombia
| | - David Gallo
- Fundación para la Prevención y Tratamiento del Cáncer, Cali, Colombia
| | - Michelle Sittig
- Institute for Cancer Care, Mercy Medical Center, Baltimore, MD
| | | | - Carol Nieroda
- Institute for Cancer Care, Mercy Medical Center, Baltimore, MD.,Fundación para la Prevención y Tratamiento del Cáncer, Cali, Colombia
| | - Katherin Zambrano-Vera
- Institute for Cancer Care, Mercy Medical Center, Baltimore, MD.,Partners for Cancer Care and Prevention, Baltimore, MD
| | - John Singer
- Partners for Cancer Care and Prevention, Baltimore, MD.,Fundación para la Prevención y Tratamiento del Cáncer, Cali, Colombia
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18
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Nikiforchin A, King MC, Baron E, MacDonald R, Sittig M, Nieroda C, Gushchin V, Sardi A. Impact of Mucin Cellularity and Distribution on Survival in Newly Diagnosed Patients with Low-Grade Appendiceal Mucinous Neoplasm Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol 2020; 27:4908-4917. [PMID: 32409962 DOI: 10.1245/s10434-020-08535-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Low-grade appendiceal mucinous neoplasms (LAMN) are tumors that frequently present with peritoneal spread of either acellular mucin (AM) or cellular mucin (CM). We aim to determine how mucin types and distribution affect survival. PATIENTS AND METHODS: A retrospective cohort study was conducted using a prospective database. Newly diagnosed LAMN patients with AM versus CM treated with cytoreductive surgery/hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) were compared. Postoperative pathology reports were reviewed to assess each involved abdominal zone. Survival was analyzed using the Kaplan-Meier method. RESULTS Of 121 identified patients, 50 (41%) had peritoneal lesions with AM and 71 (59%) with CM. Peritoneal cancer index was lower in AM versus CM (mean: 19 ± 13 vs 28 ± 10, p = 0.004), but complete cytoreduction (CC) rates were similar (98% vs 96%, p = 0.642). The 5-year progression-free survival (PFS) was higher in AM versus CM (96% vs 69.8%, p = 0.002). CM patients had zones with both types of lesions: with and without cells. The CM subgroup analysis showed significant differences in 5-year progression-free survival (PFS) among patients with 1-3, 4-7, and 8-10 zones with cells (95.2%, 68.4%, and 35.7%, respectively, p < 0.001), but PFS was not affected by the number of zones with any lesion type. There was no difference in overall survival (OS) between groups. CONCLUSIONS Despite comparable CC rates after CRS/HIPEC, CM patients have shorter PFS than AM patients. In CM patients, more zones with cells, but not the total number of involved zones, negatively impact PFS. Mucin type does not impact OS. It is important to assess and report mucin cellularity in LAMN specimens.
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Affiliation(s)
- Andrei Nikiforchin
- Department of Surgical Oncology, Mercy Medical Center, The Institute for Cancer Care at Mercy, Baltimore, MD, USA
| | - Mary Caitlin King
- Department of Surgical Oncology, Mercy Medical Center, The Institute for Cancer Care at Mercy, Baltimore, MD, USA
| | - Ekaterina Baron
- Department of Surgical Oncology, Mercy Medical Center, The Institute for Cancer Care at Mercy, Baltimore, MD, USA
| | - Ryan MacDonald
- Department of Surgical Oncology, Mercy Medical Center, The Institute for Cancer Care at Mercy, Baltimore, MD, USA
| | - Michelle Sittig
- Department of Surgical Oncology, Mercy Medical Center, The Institute for Cancer Care at Mercy, Baltimore, MD, USA
| | - Carol Nieroda
- Department of Surgical Oncology, Mercy Medical Center, The Institute for Cancer Care at Mercy, Baltimore, MD, USA
| | - Vadim Gushchin
- Department of Surgical Oncology, Mercy Medical Center, The Institute for Cancer Care at Mercy, Baltimore, MD, USA
| | - Armando Sardi
- Department of Surgical Oncology, Mercy Medical Center, The Institute for Cancer Care at Mercy, Baltimore, MD, USA.
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19
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Baron E, Gushchin V, Sittig M, Sardi A. ASO Author Reflections: When Laboratories Could Help Avoid Unnecessary Surgery. Ann Surg Oncol 2020; 27:2557-2558. [PMID: 32189168 DOI: 10.1245/s10434-020-08313-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Ekaterina Baron
- Department of Surgical Oncology, Mercy Medical Center, The Institute for Cancer Care at Mercy, Baltimore, MD, USA
| | - Vadim Gushchin
- Department of Surgical Oncology, Mercy Medical Center, The Institute for Cancer Care at Mercy, Baltimore, MD, USA
| | - Michelle Sittig
- Department of Surgical Oncology, Mercy Medical Center, The Institute for Cancer Care at Mercy, Baltimore, MD, USA
| | - Armando Sardi
- Department of Surgical Oncology, Mercy Medical Center, The Institute for Cancer Care at Mercy, Baltimore, MD, USA.
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20
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Baron E, Milovanov V, Gushchin V, Sittig M, Neiroda C, Sardi A. Predicting Aborted Hyperthermic Intraperitoneal Chemotherapy (AHIPEC) with Preoperative Tumor and Inflammatory Markers in Potentially Resectable Appendiceal Cancer Patients with Peritoneal Carcinomatosis. Ann Surg Oncol 2020; 27:2548-2556. [DOI: 10.1245/s10434-019-08117-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Indexed: 11/18/2022]
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21
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Nikiforchin A, Baron E, Sittig M, Gushchin V. Soft-Tissue Myoepithelioma of the Retroperitoneal Space Mimicking a Pancreatic Tumor: A Case Report and Literature Review. J Med Cases 2020; 11:16-21. [PMID: 34434330 PMCID: PMC8383676 DOI: 10.14740/jmc3407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 01/04/2020] [Indexed: 11/24/2022] Open
Abstract
Soft-tissue myoepithelioma (STM) is an extremely rare benign tumor with predominant occurrence in head, neck, pelvic girdle and limbs. These tumors lack specific clinical and morphological features and can easily be confused with more common neoplasms. It may lead to incorrect diagnosis and management. Here, we present a clinical case of a young man with retroperitoneal STM which simulated a pancreatic tumor and required a distal pancreatectomy. Performed literature review highlights current data about clinical, morphologic, immunohistochemical and genetic evaluation, treatment and prognosis of STM.
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Affiliation(s)
- Andrei Nikiforchin
- Institute for Cancer Care, Mercy Medical Center, Baltimore, MD 21202, USA
| | - Ekaterina Baron
- Institute for Cancer Care, Mercy Medical Center, Baltimore, MD 21202, USA
| | - Michelle Sittig
- Institute for Cancer Care, Mercy Medical Center, Baltimore, MD 21202, USA
| | - Vadim Gushchin
- Institute for Cancer Care, Mercy Medical Center, Baltimore, MD 21202, USA
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22
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Nikiforchin A, Peng R, Sittig M, Kotiah S. A Rare Case of Metastatic Heterogeneous Poorly Differentiated Neuroendocrine Carcinoma of Ileum: A Case Report and Literature Review. J Med Cases 2020; 11:6-11. [PMID: 34434328 PMCID: PMC8383677 DOI: 10.14740/jmc3401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 12/20/2019] [Indexed: 11/11/2022] Open
Abstract
Neuroendocrine neoplasms (NENs) represent a diverse group of tumors arising from neuroendocrine cells. Current World Health Organization (WHO) classification is based on tumor differentiation and grade defined by mitotic rate and/or Ki-67 index to determine prognosis and treatment options. However, some NENs do not meet WHO pathology criteria due to morphologic heterogeneity and this leads to management challenges. WHO defines poorly differentiated NENs of the gastrointestinal tract as having morphologically large or small cell features with marked elevation of Ki-67. We present a unique clinical case that does not fit either growth pattern and also has heterogeneity with a well-differentiated component. This case report and literature review highlights the current limitations of the WHO classification of small bowel NENs and the subsequent challenges in management decisions for the patients.
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Affiliation(s)
- Andrei Nikiforchin
- Department of Surgical Oncology, Mercy Medical Center, 227 Saint Paul Place, Baltimore, MD, USA
| | - Ruth Peng
- Department of Pathology, Mercy Medical Center, 345 Saint Paul Place, Baltimore, MD, USA
| | - Michelle Sittig
- Department of Surgical Oncology, Mercy Medical Center, 227 Saint Paul Place, Baltimore, MD, USA
| | - Sandy Kotiah
- Department of Medical Oncology and Hematology, Mercy Medical Center, 227 Saint Paul Place, Baltimore, MD, USA
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23
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Henningsgaard M, Sittig M, Velez-Mejia C, Sardi A. Pyoderma Gangrenosum in a Patient with Advanced Rectal Cancer Treated with Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy. Am Surg 2019; 85:e572-e574. [PMID: 31775997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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24
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Zambrano-Vera K, Sardi A, Munoz-Zuluaga C, Studeman K, Nieroda C, Sittig M, King MC, Sipok A, Gushchin V. Outcomes in Peritoneal Carcinomatosis from Appendiceal Goblet Cell Carcinoma Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS/HIPEC). Ann Surg Oncol 2019; 27:179-187. [PMID: 31646450 DOI: 10.1245/s10434-019-07932-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Appendiceal goblet cell adenocarcinoma (GCA) is often misclassified and mistreated due to mixed histologic features. In general, cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is standard of care for peritoneal carcinomatosis (PC) from mucinous appendiceal tumors; however, in PC from GCA, data are limited and the role of CRS/HIPEC is controversial. We report outcomes in PC from appendiceal GCA treated with CRS/HIPEC. PATIENTS AND METHODS A prospective institutional database of 391 CRS/HIPEC patients with appendiceal carcinomatosis from 1998 to 2018 was reviewed. Twenty-seven patients with GCA were identified. Perioperative variables were described. Survival was estimated using the Kaplan-Meier method. RESULTS GCA occurred in 7% (27/391) of appendiceal CRS/HIPEC patients. Seven (26%) cases were aborted. Two patients underwent a second CRS/HIPEC for peritoneal recurrence. Median age at diagnosis was 53 years (range 39-72 years), and 12 (60%) were female. All underwent previous surgery. Seven (35%) had prior chemotherapy and received a median of 5 cycles (range 3-8). Median PCI was 6 (range 1-39). Complete cytoreduction was achieved in 95% (19/20). Grade III complications occurred in three (15%) patients, and no perioperative deaths occurred. Median follow-up was 97 months. Overall survival at 1, 3 and 5 years was 100%, 74% and 67%, respectively. Progression-free survival at 1, 3, and 5 years was 94%, 67% and 59%, respectively. CONCLUSION CRS/HIPEC should be considered as the main treatment option for patients with PC from appendiceal GCA. When performed at a CRS/HIPEC specialty center, 5-year OS of 67% can be achieved.
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Affiliation(s)
| | - Armando Sardi
- The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA.
| | | | | | - Carol Nieroda
- The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
| | - Michelle Sittig
- The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
| | - Mary Caitlin King
- The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
| | - Arkadii Sipok
- The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
| | - Vadim Gushchin
- The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
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25
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Diaz-Montes T, Velez-Mejia C, Sittig M, MacDonald R, Gushchin V, Ducie J, Ryu H, Sardi A. Electrolyte and hematological abnormalities in patients with advanced epithelial ovarian cancers treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) or neoadjuvant chemotherapy plus CRS/HIPEC. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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26
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Diaz-Montes T, Velez-Mejia C, Sittig M, MacDonald R, Gushchin V, Ducie J, Ryu H, Sardi A. Comparison of perioperative and demographic variables among exceptional and poor responders ovarian cancer patients managed with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Baron E, Sittig M, Gushchin V. The higher school of oncology: An educational program adopting the western oncology experience in Russia. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.10512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10512 Background: Disparities in current global oncology care are a major concern for many societies. Two-year oncological training in Russia is deficient in evidence-based medicine (EBM) and effective patient communication skills, despite the fact that these dictate the ability to provide optimal cancer care. We report a 3.5-year sustained program aimed at implementing Western-oriented education among young Russian oncologists to combat these educational deficiencies. Methods: The Higher School of Oncology (HSO) is a 5-year national competitive program established to supplement the traditional 2-year Russian oncology curriculum with an emphasis on patient communication, critical appraisal of oncologic articles, multidisciplinary cancer care, and program development. A total of 35 PGY1-4 residents (8-9 residents annually) have enrolled in the program. Expatriate Russian physicians practicing in the US led 140 online educational seminars with journal clubs and clinical case presentations. Communication skills were evaluated by an independent private educational group. Results: Significant improvement of EBM knowledge was marked among HSO residents, from inability to explain basic concepts to practicing and teaching EBM. Beginning in the 3rd year of the program, residents organized educational courses and conducted journal clubs for HSO and non-HSO colleagues. Residents of the program had higher patient communication scores compared to that of residents of standard Russian programs. HSO residents promoted the spread and popularization of EBM and a patient-centered approach among attending physicians, improving the quality of cancer care. The HSO also triggered imitation of similar projects in other residency programs. Conclusions: The HSO project has pioneered EBM training and led to systemic changes in cancer patient care for Russian oncologists. This model has shown success and may be useful in overcoming global medical educational disparities in other specialties and in other countries facing similar challenges.
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Munoz-Zuluaga C, King MC, Sardi A, Ledakis P, Sittig M, Nieroda C, MacDonald R, Gushchin V. Selection and Characteristics of Patients with Peritoneal Dissemination from Appendiceal Cancer with Exceptional/Poor Survival After CRS/HIPEC. Ann Surg Oncol 2019; 26:2268-2275. [PMID: 31041628 DOI: 10.1245/s10434-019-07374-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Survival in peritoneal dissemination from appendiceal cancer after complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) varies within each histopathologic subtype. Analyzing patients with unique responses may uncover the mechanisms behind their extreme outcomes. We proposed a method to identify retrospectively and to characterize patients who responded exceptionally well or very poorly within each histopathologic subtype. METHODS Retrospective review of patients with low-grade mucinous carcinoma peritonei (LGMCP), high-grade MCP (HGMCP), and HGMCP with signet ring cells (HGMCP-S) with complete CRS/HIPEC (CC-0/1) was performed. Patients were divided by recurrence status. Median follow-up was calculated for each. Exceptional responders (ExR) were defined as alive without recurrence after median follow-up of the nonrecurrent group. Poor responders (PoR) were defined as disease recurrence before median follow-up of the recurrent group. Perioperative characteristics were analyzed. RESULTS LGMCP, HGMCP, and HGMCP-S had 48 (41%), 19 (23%), and 7 (14%) ExR and 11 (10%), 20 (24%), and 20 (39%) PoR, respectively. All ExR had lower median PCI (26 vs. 36 [p = 0.004]; 13 vs. 33.5 [p < 0.001]; 3 vs. 29.5 [p = 0.001]). Fewer LGMCP and HGMCP ExR had abnormal tumor markers (36% vs. 90% [p = 0.003]; 22% vs. 74% [p = 0.003]). More HGMCP and HGMCP-S ExR had CC-0 (vs. CC-1) cytoreductions (84% vs. 50%, p = 0.041; 100% vs. 40%, p = 0.008). CONCLUSIONS Stratifying patients by recurrence status and follow-up time successfully selects ExR and PoR within each histopathologic subtype. Perioperative characteristics of ExR versus PoR differ across histopathologic subtypes, except for disease burden. Genetic analysis may further elucidate differences and aid in the development of novel targeted therapies.
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Affiliation(s)
| | - Mary Caitlin King
- The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
| | - Armando Sardi
- The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA.
| | - Panayotis Ledakis
- The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
| | - Michelle Sittig
- The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
| | - Carol Nieroda
- The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
| | - Ryan MacDonald
- Center for Clinical Excellence, Mercy Medical Center, Baltimore, MD, USA
| | - Vadim Gushchin
- The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
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Merrell DS, McAvoy TJ, King MC, Sittig M, Millar EV, Nieroda C, Metcalf JL, Blum FC, Testerman TL, Sardi A. Pre- and post-operative antibiotics in conjunction with cytoreductive surgery and heated intraperitoneal chemotherapy (HIPEC) should be considered for pseudomyxoma peritonei (PMP) treatment. Eur J Surg Oncol 2019; 45:1723-1726. [PMID: 30770164 DOI: 10.1016/j.ejso.2019.01.223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 01/29/2019] [Indexed: 11/17/2022] Open
Abstract
Pseudomyxoma peritonei (PMP) is a subtype of peritoneal carcinomatosis that is traditionally treated by cytoreductive surgery (CRS) followed by hyperthermic intraperitoneal chemotherapy (HIPEC). A growing body of evidence suggests that microbes are associated with various tumor types and have been found in organs and cavities that were once considered sterile. Prior and ongoing research from our consortium of PMP researchers strongly suggests that bacteria are associated with PMP tumors. While the significance of this association is unclear, in our opinion, further research is warranted to understand whether these bacteria contribute to the development, maintenance and/or progression of PMP. Elucidation of a possible causal role for bacteria in PMP could suggest a benefit for supplementation of antibiotics to current treatment protocols.
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Affiliation(s)
- D Scott Merrell
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA; Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA.
| | - Thomas J McAvoy
- Department of Chemical and Biomolecular Engineering, University of Maryland, College Park, MD, 20742, USA.
| | - Mary Caitlin King
- Department of Surgical Oncology, Mercy Medical Center, Baltimore, MD, 21202, USA
| | - Michelle Sittig
- Department of Surgical Oncology, Mercy Medical Center, Baltimore, MD, 21202, USA
| | - Eugene V Millar
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD, USA
| | - Carol Nieroda
- Department of Surgical Oncology, Mercy Medical Center, Baltimore, MD, 21202, USA
| | - Jessica L Metcalf
- Department of Animal Sciences, Colorado State University, Fort Collins, CO, USA
| | - Faith C Blum
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
| | | | - Armando Sardi
- Department of Surgical Oncology, Mercy Medical Center, Baltimore, MD, 21202, USA.
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Munoz-Zuluaga C, Sardi A, King MC, Nieroda C, Sittig M, MacDonald R, Gushchin V. Outcomes in Peritoneal Dissemination from Signet Ring Cell Carcinoma of the Appendix Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol 2018; 26:473-481. [PMID: 30523470 DOI: 10.1245/s10434-018-7007-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is standard treatment for peritoneal dissemination from appendiceal cancer (AC); however, its role in high-grade histopathologic subtypes (high-grade mucinous carcinoma peritonei [HGMCP] and HGMCP with signet ring cells [HGMCP-S]) is controversial due to their aggressive behavior. This study analyzed clinical outcomes of high-grade AC after CRS/HIPEC. METHODS A prospective database of CRS/HIPEC procedures for HGMCP performed from 1998-2017 was reviewed. Perioperative variables and survival were analyzed. RESULTS Eighty-six HGMCP and 65 HGMCP-S were identified. HGMCP had more positive tumor markers (TM) (CEA/CA-125/CA-19-9) than HGMCP-S (63% vs 40%, p = 0.005). HGMCP had higher Peritoneal Cancer Index (32 vs 26, p = 0.097) and was less likely to have positive lymph nodes (LN) than HGMCP-S (28% vs 69%, p = < 0.001). Complete cytoreduction was achieved in 84% and 83%, respectively. PFS at 3- and 5-years was 59% and 48% for HGMCP vs 31% and 14% for HGMCP-S. Median PFS was 4.3 and 1.6 years, respectively (p < 0.001). OS at 3- and 5-years was 84% and 64% in HGMCP vs 38% and 25% in HGMCP-S. Median OS was 7.5 and 2.2 years, respectively (p < 0.001). LN negative HGMCP-S had longer median PFS and OS than LN positive HGMCP-S (PFS: 3.4 vs 1.5 years, p = 0.03; OS: 5.6 vs 2.1 months, p = 0.021). CONCLUSIONS The aggressive histology of HGMCP-S is associated with poor OS, has fewer abnormal TM, and is more likely to have positive LN. However, CRS/HIPEC can achieve a 5-year survival of 25%, which may improve to 51% with negative LN.
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Affiliation(s)
| | - Armando Sardi
- The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA.
| | - Mary Caitlin King
- The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
| | - Carol Nieroda
- The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
| | - Michelle Sittig
- The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
| | - Ryan MacDonald
- Center for Clinical Excellence, Mercy Medical Center, Baltimore, MD, USA
| | - Vadim Gushchin
- The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
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Sardi A, Orozco-Urdaneta M, Velez-Mejia C, Perez A, Munoz-Zuluaga C, El-Sharkawy F, Parra-Lara LG, Singer J, Sittig M. Overcoming Barriers in the Implementation of Programs for Breast and Cervical Cancer: A Pilot Model. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.10460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Breast and cervical cancers are leading causes of mortality in Latin America. Although Colombia has an integrated health system that provides universal coverage, approximately 70% of patients with cancer are diagnosed in a late stage. The government has a 10-year cancer control plan that is focused on prevention, early detection, and treatment; however, many barriers have hindered its implementation. Since 2012, Partners for Cancer Care and Prevention has worked to decrease the burden of breast and cervical cancer by mitigating the obstacles women face during their cancer journeys. Methods Through community outreach and meetings with medical personnel, hospital directors, and government officers, we identified some of the barriers—a deficit of trained personnel and physicians, limited centers and scarcity of equipment for early diagnosis, and a fragmented health system with poor continuity of care. Our proposal included monthly teleconferences, a twice-a-year on-site training and quality control program, improving the equipment for early diagnosis in easily accessible centers for patients, creating a patient navigation program and a mobile application (Amate), and unifying the system by directing patients for diagnosis to level 1 and 2 hospitals with rapid referral for treatment in level 3. Results From 2012 to 2016, we have trained 462 health professionals in the screening, diagnosis, and treatment of breast and cervical cancers and equipped level 1 and 2 hospitals for cancer diagnosis by donating a mammography machine and two video colposcopes, all of which has yielded 3,036 mammograms and 1,500 uterocervical cytologies annually. In addition, Amate is able to provide basic teaching and rapid referral for screening. Thus far, 2,583 women have benefited from the program. This has integrated the health system and shortened wait times. After 4 years, the time from initial consult to biopsy has decreased from 65 days to 20 days (70%), from biopsy to surgery for 154 days to 64 days, and from biopsy to chemotherapy from 148 days to 72 days. Conclusion A system of early diagnosis in level 1 and 2 hospitals—now centers of excellence—with rapid referral to a tertiary care institution has facilitated the implementation of the cancer program in Colombia. Although several barriers are still to be addressed, we are establishing an efficient health care model that could be replicated in other underserved countries. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . Armando Sardi Stock or Other Ownership: Celgene, Johnson & Johnson Mavalynne Orozco-Urdaneta Employment: Partners For Cancer Care And Prevention Foundation, Stamina-in-Action Stock or Other Ownership: Celgene, Johnson & Johnson Luis Gabriel Parra-Lara Research Funding: Merk & Co
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Affiliation(s)
- Armando Sardi
- Armando Sardi, Carolina Velez-Mejia, Carlos Munoz-Zuluaga, Farah El-Sharkawy, and Michelle Sittig, Mercy Medical Center; Armando Sardi, Mavalynne Orozco-Urdaneta, and John Singer, Partners for Cancer Care and Prevention, Baltimore, MD; Andres Perez and Luis Gabriel Parra-Lara, Fundación Para la Prevención y Tratamiento del Cáncer, Cali, Colombia
| | - Mavalynne Orozco-Urdaneta
- Armando Sardi, Carolina Velez-Mejia, Carlos Munoz-Zuluaga, Farah El-Sharkawy, and Michelle Sittig, Mercy Medical Center; Armando Sardi, Mavalynne Orozco-Urdaneta, and John Singer, Partners for Cancer Care and Prevention, Baltimore, MD; Andres Perez and Luis Gabriel Parra-Lara, Fundación Para la Prevención y Tratamiento del Cáncer, Cali, Colombia
| | - Carolina Velez-Mejia
- Armando Sardi, Carolina Velez-Mejia, Carlos Munoz-Zuluaga, Farah El-Sharkawy, and Michelle Sittig, Mercy Medical Center; Armando Sardi, Mavalynne Orozco-Urdaneta, and John Singer, Partners for Cancer Care and Prevention, Baltimore, MD; Andres Perez and Luis Gabriel Parra-Lara, Fundación Para la Prevención y Tratamiento del Cáncer, Cali, Colombia
| | - Andres Perez
- Armando Sardi, Carolina Velez-Mejia, Carlos Munoz-Zuluaga, Farah El-Sharkawy, and Michelle Sittig, Mercy Medical Center; Armando Sardi, Mavalynne Orozco-Urdaneta, and John Singer, Partners for Cancer Care and Prevention, Baltimore, MD; Andres Perez and Luis Gabriel Parra-Lara, Fundación Para la Prevención y Tratamiento del Cáncer, Cali, Colombia
| | - Carlos Munoz-Zuluaga
- Armando Sardi, Carolina Velez-Mejia, Carlos Munoz-Zuluaga, Farah El-Sharkawy, and Michelle Sittig, Mercy Medical Center; Armando Sardi, Mavalynne Orozco-Urdaneta, and John Singer, Partners for Cancer Care and Prevention, Baltimore, MD; Andres Perez and Luis Gabriel Parra-Lara, Fundación Para la Prevención y Tratamiento del Cáncer, Cali, Colombia
| | - Farah El-Sharkawy
- Armando Sardi, Carolina Velez-Mejia, Carlos Munoz-Zuluaga, Farah El-Sharkawy, and Michelle Sittig, Mercy Medical Center; Armando Sardi, Mavalynne Orozco-Urdaneta, and John Singer, Partners for Cancer Care and Prevention, Baltimore, MD; Andres Perez and Luis Gabriel Parra-Lara, Fundación Para la Prevención y Tratamiento del Cáncer, Cali, Colombia
| | - Luis Gabriel Parra-Lara
- Armando Sardi, Carolina Velez-Mejia, Carlos Munoz-Zuluaga, Farah El-Sharkawy, and Michelle Sittig, Mercy Medical Center; Armando Sardi, Mavalynne Orozco-Urdaneta, and John Singer, Partners for Cancer Care and Prevention, Baltimore, MD; Andres Perez and Luis Gabriel Parra-Lara, Fundación Para la Prevención y Tratamiento del Cáncer, Cali, Colombia
| | - John Singer
- Armando Sardi, Carolina Velez-Mejia, Carlos Munoz-Zuluaga, Farah El-Sharkawy, and Michelle Sittig, Mercy Medical Center; Armando Sardi, Mavalynne Orozco-Urdaneta, and John Singer, Partners for Cancer Care and Prevention, Baltimore, MD; Andres Perez and Luis Gabriel Parra-Lara, Fundación Para la Prevención y Tratamiento del Cáncer, Cali, Colombia
| | - Michelle Sittig
- Armando Sardi, Carolina Velez-Mejia, Carlos Munoz-Zuluaga, Farah El-Sharkawy, and Michelle Sittig, Mercy Medical Center; Armando Sardi, Mavalynne Orozco-Urdaneta, and John Singer, Partners for Cancer Care and Prevention, Baltimore, MD; Andres Perez and Luis Gabriel Parra-Lara, Fundación Para la Prevención y Tratamiento del Cáncer, Cali, Colombia
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Diaz-Montes T, El-Sharkawy F, Gushchin V, Ryu H, Sittig M, Sardi A. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy as initial treatment of ovarian, fallopian tube, and primary peritoneal cancer: Preliminary results of a phase II randomized clinical trial. Gynecol Oncol 2018. [DOI: 10.1016/j.ygyno.2018.04.079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Sittig M, David J, Yoshida E, Reznik R, McArthur H, Chung A, Mita M, Amersi F, Giuliano A, Cook-Wiens G, Shiao S. Effect of Age in Young Women With Stage I-III Triple-Negative Breast Cancer: A Report From the National Cancer Database. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Munoz-Zuluaga CA, Sardi A, Sittig M, Eskay V, Nieroda CA, El-Sharkawy F, Sipok A, Gushchin V. Long-term outcomes with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in peritoneal carcinomatosis from appendiceal cancer: An 18-year experience. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.4098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4098 Background: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) have become standard of care for patients with peritoneal carcinomatosis (PC) from appendiceal cancer (AC). We reviewed our experience and outcomes. Methods: A retrospective review of 614 CRS/HIPEC procedures from 1998-2016 was performed. Patient characteristics, surgical variables, and postoperative outcomes of first CRS/HIPEC were analyzed. Results: Two hundred ninety patients with PC from AC underwent 334 CRS/HIPEC’s. Median age at diagnosis and surgery was 52 (22-79) and 53 (23-81) years, respectively; 65% (187) were female. Prior surgical score was 0, 1, 2, and 3 in 20%, 38%, 37%, and 5%, respectively. Prior systemic chemotherapy was reported in 30% of patients. Median time from diagnosis to CRS/HIPEC was 4 months (0-182). Pre-operative tumor markers (CEA, CA-125, CA-19-9) were positive in 48% with one, two, and three positive markers in 21%, 15%, and 13% patients, respectively. Median Peritoneal Cancer Index was 29. Mitomycin-C was the HIPEC agent of choice. Mean operative time was 10 hours (R: 4-19) and median length of stay was 10 days (R: 4-93). Histology included 59% (171) peritoneal mucinous carcinomatosis (PMCA), 41% (119) disseminated peritoneal adenomucinosis (DPAM). Lymph nodes were positive in 47% PMCA. Complete cytoreduction rate was 87% (84% PMCA, 92% DPAM [p = 0.048]). Grade III-V complications occurred in 21%, with one 30-day mortality (0.3%). Overall, median progression-free survival (PFS) was 84 months with 5-year PFS of 56%. Median PFS was 43 months in PMCA and not reached in DPAM. Five year PFS was 40% PMCA and 82% DPAM (p < 0.001). Median overall survival (MOS) was 139 months with 61% 5-year OS. MOS was 53 months in PMCA and not reached in DPAM. Five year OS was 47% PMCA and 85% DPAM (p < 0.001). At 42-month median follow-up, 68% were alive (92 PMCA/103 DPAM) with 84% disease free (72 PMCA/92 DPAM), 28% died of disease (73 PMCA/7 DPAM). Conclusions: CRS/HIPEC is an effective treatment for patients with PC from AC providing meaningful long term survival in low and high grade tumors and should be considered the standard of care.
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Milovanov V, Sardi A, Aydin N, Nieroda C, Sittig M, Gushchin V. External Validation of the Simplified Preoperative Assessment for Low-Grade Mucinous Adenocarcinoma of the Appendix. Ann Surg Oncol 2017; 24:1783-1786. [PMID: 28315061 DOI: 10.1245/s10434-017-5794-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND MD Anderson Cancer Center developed a computed tomography (CT)-based preoperative assessment tool simplified preoperative assessment for appendix tumor (SPAAT) for predicting incomplete cytoreduction (IC) in low-grade mucinous adenocarcinoma (LGMA) of the appendix, based on preoperative CT scans. This study independently evaluates the tool's performance. METHODS Seventy-six preoperative CT scans of LGMA patients were evaluated by two surgeons unfamiliar with the patients' medical history. Scores were assigned based on SPAAT criteria, with a SPAAT ≥3 predictive of IC. Binary regression analyses and area under the receiver operating characteristic (AUROC) curve analyses were performed. Patients with splenic resection were excluded due to the structure of the SPAAT assessment tool. RESULTS Seventy-six LGMA patients underwent attempted cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). Of 68 patients, 58 had complete cytoreduction and 10 had IC; 8 patients were ineligible due to prior splenectomy. The mean SPAAT score was 0.8, with six patients having SPAAT scores ≥3. SPAAT scores ≥3 were predictive of IC, with a hazard ratio (HR) of 19 (95% confidence interval 2.8-124.1) (p = 0.002). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value were 40, 97, 50, and 90%, respectively. A SPAAT score ≥3 was not associated with worse survival prognosis. Median follow-up was 2.4 years and AUROC curve was 71%. SPAAT components with respective HR and p-values were foreshortening of the bowel mesentery (29.5; p = 0.004), and scalloping of the pancreas (9; p = 0.008), spleen (4.3; p = 0.04), portal vein (3.1; p = 0.4), and liver (2.1; p = 0.3). CONCLUSION A SPAAT score ≥3 predicted IC based on a binary regression model. The clinical value of this score is controversial due to low sensitivity and PPV.
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Affiliation(s)
- Vladimir Milovanov
- Department of Surgical Oncology, Mercy Medical Center, Baltimore, MD, 21202-2001, USA
| | - Armando Sardi
- Department of Surgical Oncology, Mercy Medical Center, Baltimore, MD, 21202-2001, USA.
| | - Nail Aydin
- Department of Surgical Oncology, Mercy Medical Center, Baltimore, MD, 21202-2001, USA
| | - Carol Nieroda
- Department of Surgical Oncology, Mercy Medical Center, Baltimore, MD, 21202-2001, USA
| | - Michelle Sittig
- Department of Surgical Oncology, Mercy Medical Center, Baltimore, MD, 21202-2001, USA
| | - Vadim Gushchin
- Department of Surgical Oncology, Mercy Medical Center, Baltimore, MD, 21202-2001, USA
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Sittig M, Mirhadi A, Reznik R, Giuliano A, Amersi F, Chung A, Karlan S, Funk K, Shiao S. Does Prior Breast Augmentation Negatively Impact the Dosimetry of Brachytherapy-Delivered Accelerated Partial Breast Irradiation? Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Diaz-Montes T, Sittig M, Ryu H, Gushchin V, Sardi A. A phase II randomized study: Outcomes after cytoreductive surgery (CRS) with or without carboplatin hyperthermic intraperitoneal chemotherapy (HIPEC) followed by adjuvant chemotherapy as initial treatment of advanced stage (stage III/IV) ovarian, fallopian tube, and primary peritoneal cancer. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e17080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Lynam S, Diaz-Montes T, Harper A, Sittig M, MacDonald R, Gushchin V, Sardi A. Efficacy of hyperthermic intraperitoneal chemotherapy and cytoreductive surgery in treatment of recurrent uterine sarcoma. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e17122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Sardi A, Milovanov V, Sittig M, Gushchin V. The role of cytoreductive surgery and heated intraperitoneal chemotherapy (CRS/HIPEC) in patients with peritoneal carcinomatosis (PC) of appendiceal origin (AO). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.4_suppl.707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
707 Background: Peritoneal carcinomatosis of mucinous appendiceal tumor origin is a rare condition which has poor prognosis if treated with limited surgery or systemic chemotherapy. Several publications show that CRS/HIPEC gives a significant survival benefit for patients with PC of AO. However, many patients do not get appropriate treatment. We show data from our 17-year experience using CRS/HIPEC in PC of AO. Methods: Retrospective analysis of a prospective database of 251 patients with PC of AO was performed. Peritoneal cancer index (PCI), completeness of cytoreduction (CC), lymph node (LN) status, and histopathology data was collected. The impact of each variable evaluated by Hazard ratio analysis. Overall survival (OS) estimated by Kaplan-Meier curves. Results: Mean age 53 years (range 23-81). 251 patients underwent 290 CRS/HIPEC procedures. 31 patients had 2, and 4 patients had 3 CRS/HIPEC. A total of 149 patients (59%) had peritoneal mucinous carcinomatosis (PMCA) and 102 (41%) had disseminated peritoneal adenomucinosis (DPAM) (Ronnett classification). Mean follow-up 4.8 years with a median of 4.7 years. Complete cytoreduction was achieved in 84% (89% DPAM, 80% PMCA; p = 0.047). Mean length of surgery 11.3 hours, mean hospital stay 14 days. No in-hospital or 30-day mortality. 73% had PCI > 20 (78% DPAM; 68% PMCA). LN metastasis in 42% with PMCA. OS from date of HIPEC was 93%, 86%, 81% in DPAM and 90%, 60%, 44% in PMCA for 1, 3, and 5 years, respectively. With CC, the 5-year OS was 84% in DPAM and 49% in PMCA. All PMCA patients with incomplete cytoreduction (n = 30) had PCI ≥ 20 (p < 0.001). Hazard ratios were 2.5 (95% confidence interval [95% CI] 1.3-4.5), 3.1 (95% CI 2.0-4.9), 3.6 (95% CI 2.1-6.2), for PCI < 20, complete cytoreduction, and histopathology (DPAM vs. PMCA), respectively. Hazard ratio (for LN status in patients with PMCA was 3.0 (95% CI 1.8-5.1). Conclusions: Meaningful survival could be achieved in PC of AO even with extensive peritoneal disease (PCI > 20). We consider CRS/HIPEC a standard of care for these patients. CRS/HIPEC should be provided in specialized centers by trained surgeons where complete cytoreduction could be frequently accomplished.
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Milovanov V, Sardi A, Studeman K, Nieroda C, Sittig M, Gushchin V. The 7th Edition of the AJCC Staging Classification Correlates with Biologic Behavior of Mucinous Appendiceal Tumor with Peritoneal Metastases Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS/HIPEC). Ann Surg Oncol 2015; 23:1928-33. [DOI: 10.1245/s10434-015-5047-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Indexed: 12/16/2022]
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Aydin N, Sardi A, Milovanov V, Nieroda C, Sittig M, Nunez MF, Jimenez W, Gushchin V. Outcomes of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Mesothelioma: Experience of a Peritoneal Surface Malignancy Center. Am Surg 2015; 81:1253-1259. [PMID: 26736164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Diffuse malignant peritoneal mesothelioma (DMPM) is an uncommon malignancy, which can be difficult to treat. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have evolved as the treatment of choice when complete cytoreduction is to be achieved. This study reports the outcomes of CRS/HIPEC for peritoneal mesothelioma performed in a center for peritoneal surface malignancy. A retrospective analysis of a prospective database of 389 CRS/HIPEC procedures identified 23 patients who underwent CRS/HIPEC for DMPM from 1999 to 2014. Gender, age at diagnosis, age at surgery, previous surgeries, follow-up time, peritoneal cancer index (PCI) score, completeness of cytoreduction (CC), pathology, and overall survival (OS) were analyzed. The univariate analysis was used to determine the prognostic value of age, gender, neoadjuvant chemotherapy, histopathology of the tumor, PCI, CC, and lymph node status on survival. Mean follow-up time from surgery was 31 months (range = 0.5-124). The median PCI score was 28, and 77 per cent had PCI ≥20. CC 0-1 was achieved in 65 per cent of cases. One- and 5-year actuarial OS rates from diagnosis were 86 per cent and 60 per cent, respectively. One- and 5-year actuarial OS from HIPEC was 70 per cent and 64 per cent, respectively. The univariate analysis showed that the CC was the only significant prognostic factor. Patients with DMPM may achieve long-term survival when treated with CRS/HIPEC. The CC is the most significant prognostic factor for long-term survival.
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Affiliation(s)
- Nail Aydin
- Department of Surgical Oncology, Institute for Cancer Care at Mercy Medical Center, Baltimore, Maryland, USA
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Aydin N, Sardi A, Milovanov V, Nieroda C, Sittig M, Nunez MF, Jimenez W, Gushchin V. Outcomes of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Mesothelioma: Experience of a Peritoneal Surface Malignancy Center. Am Surg 2015. [DOI: 10.1177/000313481508101228] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Diffuse malignant peritoneal mesothelioma (DMPM) is an uncommon malignancy, which can be difficult to treat. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have evolved as the treatment of choice when complete cytoreduction is to be achieved. This study reports the outcomes of CRS/HIPEC for peritoneal mesothelioma performed in a center for peritoneal surface malignancy. A retrospective analysis of a prospective database of 389 CRS/ HIPEC procedures identified 23 patients who underwent CRS/HIPEC for DMPM from 1999 to 2014. Gender, age at diagnosis, age at surgery, previous surgeries, follow-up time, peritoneal cancer index (PCI) score, completeness of cytoreduction (CC), pathology, and overall survival (OS) were analyzed. The univariate analysis was used to determine the prognostic value of age, gender, neoadjuvant chemotherapy, histopathology of the tumor, PCI, CC, and lymph node status on survival. Mean follow-up time from surgery was 31 months (range = 0.5–124). The median PCI score was 28, and 77 per cent had PCI ≥20. CC 0–1 was achieved in 65 per cent of cases. One- and 5-year actuarial OS rates from diagnosis were 86 per cent and 60 per cent, respectively. One- and 5-year actuarial OS from HIPEC was 70 per cent and 64 per cent, respectively. The univariate analysis showed that the CC was the only significant prognostic factor. Patients with DMPM may achieve long-term survival when treated with CRS/HIPEC. The CC is the most significant prognostic factor for long-term survival.
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Affiliation(s)
- Nail Aydin
- Department of Surgical Oncology, Institute for Cancer Care at Mercy Medical Center, Baltimore, Maryland
| | - Armando Sardi
- Department of Surgical Oncology, Institute for Cancer Care at Mercy Medical Center, Baltimore, Maryland
| | - Vladimir Milovanov
- Department of Surgical Oncology, Institute for Cancer Care at Mercy Medical Center, Baltimore, Maryland
| | - Carol Nieroda
- Department of Surgical Oncology, Institute for Cancer Care at Mercy Medical Center, Baltimore, Maryland
| | - Michelle Sittig
- Department of Surgical Oncology, Institute for Cancer Care at Mercy Medical Center, Baltimore, Maryland
| | - Maria F. Nunez
- Department of Surgical Oncology, Institute for Cancer Care at Mercy Medical Center, Baltimore, Maryland
| | - William Jimenez
- Department of Surgical Oncology, Institute for Cancer Care at Mercy Medical Center, Baltimore, Maryland
| | - Vadim Gushchin
- Department of Surgical Oncology, Institute for Cancer Care at Mercy Medical Center, Baltimore, Maryland
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Milovanov V, Sardi A, Aydin N, Nieroda C, Sittig M, Nunez M, Gushchin V. Extensive surgical history prior to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy is associated with poor survival outcomes in patients with peritoneal mucinous carcinomatosis of appendiceal origin. Eur J Surg Oncol 2015; 41:881-5. [DOI: 10.1016/j.ejso.2015.02.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 01/30/2015] [Accepted: 02/12/2015] [Indexed: 11/28/2022] Open
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Milovanov V, Sardi A, Ledakis P, Aydin N, Nieroda C, Sittig M, Nunez M, Gushchin V. Systemic chemotherapy (SC) before cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) in patients with peritoneal mucinous carcinomatosis of appendiceal origin (PMCA). Eur J Surg Oncol 2015; 41:707-12. [PMID: 25633641 DOI: 10.1016/j.ejso.2015.01.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 12/08/2014] [Accepted: 01/07/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The role of SC before CRS/HIPEC for patients with PMCA is unclear. This study explores the effect of SC prior to CRS/HIPEC on overall survival (OS) in patients with PMCA. METHODS 72 patients with recently diagnosed PMCA who underwent CRS/HIPEC were identified from a prospective database. Thirty patients had SC before CRS/HIPEC (Group 1) and 42 did not (Group 2). Patients who were referred to our center after multiple lines of SC were excluded from this analysis. OS was estimated. RESULTS Median follow-up was 3.2 years. Groups were similar regarding lymph node positivity, postoperative SC and rate of complete cytoreduction. Twenty-four (80%) patients in Group 1 and 21 (50%) in Group 2 had high grade histology (HG) (p = 0.01). OS from CRS/HIPEC at 1, 2, and 3 years was 93, 68, 51% in Group 1 and 82, 64, 60% in Group 2, respectively (p = 0.74). Among HG patients 3-year survival was 36% in the SC group vs. 35% in the group without SC (p = 0.67). The 3-year OS for patients with low grade (LG) tumors was 100% in the SC group vs. 79% in the group with no prior SC (p = 0.26). Among patients with signet ring cell (SRC) histology, 1, 2 and 3-year survival was 94, 67 and 22% in the SC group vs. 43, 14, 14% in the group with no SC, respectively (p = 0.028). There were only 6 patients with LG PMCA who received prior SC. CONCLUSIONS Preoperative SC could improve the prognosis of patients with high-grade PMCA with SRC histology.
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Affiliation(s)
- V Milovanov
- Department of Surgical Oncology, Mercy Medical Center, 227 St Paul Place, Baltimore, MD 21202-2001, USA.
| | - A Sardi
- Department of Surgical Oncology, Mercy Medical Center, 227 St Paul Place, Baltimore, MD 21202-2001, USA.
| | - P Ledakis
- Department of Surgical Oncology, Mercy Medical Center, 227 St Paul Place, Baltimore, MD 21202-2001, USA.
| | - N Aydin
- Department of Surgical Oncology, Mercy Medical Center, 227 St Paul Place, Baltimore, MD 21202-2001, USA.
| | - C Nieroda
- Department of Surgical Oncology, Mercy Medical Center, 227 St Paul Place, Baltimore, MD 21202-2001, USA.
| | - M Sittig
- Department of Surgical Oncology, Mercy Medical Center, 227 St Paul Place, Baltimore, MD 21202-2001, USA.
| | - M Nunez
- Department of Surgical Oncology, Mercy Medical Center, 227 St Paul Place, Baltimore, MD 21202-2001, USA.
| | - V Gushchin
- Department of Surgical Oncology, Mercy Medical Center, 227 St Paul Place, Baltimore, MD 21202-2001, USA.
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Milovanov V, Sardi A, Aydin N, Sittig M, Nieroda C, Gushchin V. 46. Extensive surgical history prior to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy associated with poor survival outcomes in patients with peritoneal mucinous carcinomatosis of appendiceal origin. Eur J Surg Oncol 2014. [DOI: 10.1016/j.ejso.2014.08.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Nunez MF, Sardi A, Jimenez W, Nieroda C, Sittig M, MacDonald R, Aydin N, Milovanov V, Gushchin V. Port-Site Metastases is an Independent Prognostic Factor in Patients with Peritoneal Carcinomatosis. Ann Surg Oncol 2014; 22:1267-73. [DOI: 10.1245/s10434-014-4136-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Indexed: 02/06/2023]
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Nunez MF, Sardi A, Nieroda C, Jimenez W, Sittig M, MacDonald R, Aydin N, Milovanov V, Gushchin V. Morbidity of the Abdominal Wall Resection and Reconstruction After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS/HIPEC). Ann Surg Oncol 2014; 22:1658-63. [DOI: 10.1245/s10434-014-4075-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Indexed: 01/07/2023]
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Jimenez W, Sardi A, Nieroda C, Sittig M, Milovanov V, Nunez M, Aydin N, Gushchin V. Predictive and Prognostic Survival Factors in Peritoneal Carcinomatosis from Appendiceal Cancer After Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol 2014; 21:4218-25. [DOI: 10.1245/s10434-014-3869-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Indexed: 12/23/2022]
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Milovanov V, Sardi A, Ledakis P, Aydin N, Jimenez WA, Sittig M, Macdonald R, Gushchin V. Systemic chemotherapy (SC) before cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with peritoneal mucinous carcinomatosis of appendiceal origin (PMCA). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e15179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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