title: Aggressive locoregional management of recurrent peritoneal sarcomatosis.
abstract: OBJECTIVE
  Peritoneal sarcomatosis responds poorly to systemic chemotherapy and demonstrates high rates of recurrence after resection. We sought to determine perioperative and oncologic outcomes after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemoperfusion (HIPEC) for recurrent sarcomatosis.
  
  
  METHODS
  We reviewed 15 patients undergoing 17 CRS/HIPEC for recurrent sarcomatosis from a prospective database.
  
  
  RESULTS
  There were four synovial cell sarcomas, five liposarcomas, three leiomyosarcomas, two gastrointestinal stromal tumors (GIST), and three other sarcomas. Adequate cytoreduction (CC-0/1) was achieved in all patients, with a median intra-operative Simplified Peritoneal Carcinomatosis Index of 6 (range: 3-9). Median blood loss and operative time were 1 L (range: 450-5,200) and 402 min (range: 324-680), respectively. Chemoperfusion drug was mitomycin C, cisplatin, or doxorubicin. Significant post-operative complications (Clavien-Dindo III/IV) occurred in four (24%) patients, with no 60-day mortalities and three (18%) 60-day re-admissions. Median intra-abdominal disease-free and overall survival after CRS/HIPEC was 17.2 (95% CI: 2.4-19.7 months) and 22.6 months (95% CI: 6.1-62.6 months), respectively. There was a trend towards delayed recurrence after combined CRS/HIPEC than after prior CRS alone (17.2 months vs. 10.7 months, respectively; P = 0.52).
  
  
  CONCLUSIONS
  Cytoreduction combined with HIPEC may improve loco-regional disease control in patients with recurrent sarcomatosis.
authors: Division of Surgical Oncology, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors: Joel M
authors: JM
authors: Baumgartner
authors: Steven A
authors: SA
authors: Ahrendt
authors: James F
authors: JF
authors: Pingpank
authors: Matthew P
authors: MP
authors: Holtzman
authors: Lekshmi
authors: L
authors: Ramalingam
authors: Heather L
authors: HL
authors: Jones
authors: Amer H
authors: AH
authors: Zureikat
authors: Herbert J
authors: HJ
authors: Zeh
authors: David L
authors: DL
authors: Bartlett
authors: Haroon A
authors: HA
authors: Choudry
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D017024:Chemotherapy, Adjuvant; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods; D002945:Cisplatin / Q000008:administration & dosage; D016208:Databases, Factual; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D046152:Gastrointestinal Stromal Tumors / Q000628:therapy; D006801:Humans; D006979:Hyperthermia, Induced; D053208:Kaplan-Meier Estimate; D007890:Leiomyosarcoma / Q000628:therapy; D008080:Liposarcoma / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000473:pathology / Q000517:prevention & control / Q000601:surgery / Q000628:therapy*; D010414:Pennsylvania / Q000453:epidemiology; D010534:Peritoneal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies; D012509:Sarcoma / Q000188:drug therapy / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D013584:Sarcoma, Synovial / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D016685:Mitomycin; D004317:Doxorubicin; D002945:Cisplatin