Review of a personal experience in the management of carcinomatosis and sarcomatosis.
BACKGROUND
Peritoneal surface malignancy can result from seeding of gastrointestinal cancer or abdomino-pelvic sarcoma; it can also occur as a primary disease, such as peritoneal mesothelioma. In the past, this clinical situation was treated only with palliative intent.


METHODS
An aggressive approach to peritoneal surface malignancy involves peritonectomy procedures, perioperative intraperitoneal chemotherapy and knowledgeable patient selection. The clinical assessments necessary for valid clinical judgements include the cancer histopathology (invasive vs expansive progression), the preoperative abdominal and pelvic CT, the peritoneal cancer index and the completeness of cytoreduction score. Proper patient selection is mandatory for optimizing the results of treatment.


RESULTS
In a series of phase II studies, appendiceal tumors with peritoneal seeding became the paradigm for success with an 85% long-term survival in selected patients. Carcinomatosis from colon cancer had an overall 5-year survival of 50% with selected patients. Also, sarcomatosis patients overall had a 40% 5-year survival in selected patients. Peritoneal mesothelioma showed a 36% 5-year survival. In all malignancies, early aggressive treatment of minimal peritoneal surface dissemination showed the greatest benefit.


CONCLUSIONS
Oncologists must accept responsibility for knowledgeable management of peritoneal surface dissemination of cancer because a curative approach has been demonstrated in large phase II studies and all historical controls show 0% long-term survival. Adjuvant phase III studies with perioperative intraperitoneal chemotherapy in diseases where peritoneal surface spread occurs are indicated.
Sugarbaker
P H
PH
Washington Cancer Institute, Washington Hospital Center, DC 20010, USA. paul.surgarbuker@medstar.net
D000970:Antineoplastic Agents / Q000008:administration & dosage*; D002277:Carcinoma / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D005770:Gastrointestinal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D006801:Humans; D007263:Infusions, Parenteral; D008654:Mesothelioma / Q000188:drug therapy; D009366:Neoplasm Seeding; D018579:Patient Selection; D010534:Peritoneal Neoplasms / Q000188:drug therapy* / Q000601:surgery; D010537:Peritoneum / Q000601:surgery; D012509:Sarcoma / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D024162:Second-Look Surgery; D015996:Survival Rate
D000970:Antineoplastic Agents