Cytoreduction and HIPEC in the treatment of "unconventional" secondary peritoneal carcinomatosis.
BACKGROUND
Peritoneal metastasis (PM) is considered a terminal and incurable disease. In the last 30 years, cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) radically changed the therapeutic approach for these patients and is regarded as the standard of care for pseudomyxoma peritonei from appendiceal cancer and peritoneal mesotheliomas. Improved survival has also been reported in treating PM from ovarian, gastric, and colorectal cancers. However, PM often seriously complicates the clinical course of patients with other primary digestive and non-digestive cancers. There is increasing literature evidence that helped to identify not only the primary tumors for which CRS and HIPEC showed a survival advantage but also the patients who may benefit form this treatment modality for the potential lethal complications. Our goal is to report our experience with cytoreduction and HIPEC in patients with PM from rare or unusual primary tumors, discussing possible "unconventional" indications, outcome, and the peculiar issues related to each tumor.


METHODS
From a series of 253 consecutive patients with a diagnosis of peritoneal carcinomatosis and treated by CRS and HIPEC, we selected only those with secondary peritoneal carcinomatosis from rare or unusual primary tumors, excluding pseudomyxoma peritonei, peritoneal mesotheliomas, ovarian, gastric, and colorectal cancers. Complications and adverse effects were graded from 0 to 5 according to the WHO Common Toxicity Criteria for Adverse Events (CTCAE). Survival was expressed as mean and median.


RESULTS
We admitted and treated by CRS and HIPEC 28 patients with secondary peritoneal carcinomatosis from rare or unusual primary tumors. Morbidity and mortality rates were in line with those reported for similar procedures. Median survival for the study group was 56 months, and 5-year overall survival reached 40.3 %, with a difference between patients with no (CC0) and minimal (CC1) residual disease (52.3 vs. 25.7), not reaching statistical significance. Ten patients are alive disease-free, and eight are alive with disease.


CONCLUSIONS
Cytoreduction and HIPEC should not be excluded "a priori" for the treatment of peritoneal metastases from unconventional primary tumors. This combined therapeutic approach, performed in an experienced center, is safe and can provide a survival benefit over conventional palliative treatments.
UOC Tecnologie Chirurgiche e Day Surgery, Dipartimento di Chirurgia "P. Valdoni", "Sapienza" Università di Roma, Rome, Italy. maurizio.cardi@uniroma1.it.|, Via Bolzano 32, 00198, Rome, Italy. maurizio.cardi@uniroma1.it.
Maurizio
M
Cardi
UOC Tecnologie Chirurgiche e Day Surgery, Dipartimento di Chirurgia "P. Valdoni", "Sapienza" Università di Roma, Rome, Italy. paolo.sammartino@uniroma1.it.
Paolo
P
Sammartino
UOC Tecnologie Chirurgiche e Day Surgery, Dipartimento di Chirurgia "P. Valdoni", "Sapienza" Università di Roma, Rome, Italy. valentinamingarelli@libero.it.
Valentina
V
Mingarelli
UOC Tecnologie Chirurgiche e Day Surgery, Dipartimento di Chirurgia "P. Valdoni", "Sapienza" Università di Roma, Rome, Italy. simone.sibio@uniroma1.it.
Simone
S
Sibio
UOC Tecnologie Chirurgiche e Day Surgery, Dipartimento di Chirurgia "P. Valdoni", "Sapienza" Università di Roma, Rome, Italy. fabio.accarpio@uniroma1.it.
Fabio
F
Accarpio
UOC Tecnologie Chirurgiche e Day Surgery, Dipartimento di Chirurgia "P. Valdoni", "Sapienza" Università di Roma, Rome, Italy. daniele.biacchi@uniroma1.it.
Daniele
D
Biacchi
Dipartimento di Scienze Radioterapiche, Oncologiche ed Anatomopatologiche, "Sapienza" Università di Roma, Rome, Italy. daniela.musio@uniroma1.it.
Daniela
D
Musio
UOC Tecnologie Chirurgiche e Day Surgery, Dipartimento di Chirurgia "P. Valdoni", "Sapienza" Università di Roma, Rome, Italy. bianca.sollazzo@gmail.com.
Bianca
B
Sollazzo
UOC Tecnologie Chirurgiche e Day Surgery, Dipartimento di Chirurgia "P. Valdoni", "Sapienza" Università di Roma, Rome, Italy. angelo.digiorgio@uniroma1.it.
Angelo
A
Di Giorgio
D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols; D065426:Cytoreduction Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
D000970:Antineoplastic Agents