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Do all patients that undergo a ‘complete’ secondary cytoreductive surgery for platinum-sensitive recurrent ovarian cancer, benefit from it? 是否所有接受 "完全 "二次细胞剥脱手术的铂敏感复发性卵巢癌患者都能从中获益?
IF 1.4 Q4 ONCOLOGY Pub Date : 2024-07-08 DOI: 10.1515/pp-2023-0052
A. Bhatt, S. Mehta, O. Glehen
Abstract Following the results of three randomized trials (GOG-213, DESKTOP-III, and SOC-1), secondary cytoreductive surgery (sCRS) is recommended as a therapeutic option for all patients with platinum-sensitive recurrence by the NCCN guidelines and for oligometastatic recurrence by the ESMO-ESGO guidelines. Criteria for predicting a complete gross resection (CGR) were used to select patients for sCRS in all three trials. No trial used surgical prognostic factors like disease sites or disease extent for stratification. The outcomes of sCRS varied in preplanned/post-hoc subgroup analyses. The survival following an incomplete CRS was worse than with systemic chemotherapy alone. Not all patients will benefit similarly from sCRS, even if a CGR is obtained. No trial evaluated the benefit of sCRS in patients receiving poly-ADP ribose polymerase (PARP) inhibitors. While GOG-213 showed no benefit of sCRS when bevacizumab was used, the role of bevacizumab in patients having a CGR was not evaluated. The use of targeted therapies during first-line therapy is increasing, affecting treatment decisions and future clinical trial designs. New trials on sCRS should stratify patients according to surgical prognostic factors; sub-group analyses should be performed only in patients with CGR. Highlights – Selection criteria used in all three randomized trials are predictive of a complete cytoreduction and not the benefit of surgery – Post-hoc & prespecified subgroup analyses indicate that not all patients undergoing secondary cytoreduction benefit from it – Post-hoc and sub-group analysis should be performed separately for patients undergoing a complete gross resection – Impact of incomplete cytoreduction on quality of life and subsequent therapy needs further evaluation – Future randomized trials should use surgical prognostic factors like disease sites and extent as stratification factors
摘要 根据三项随机试验(GOG-213、DESKTOP-III 和 SOC-1)的结果,NCCN 指南和 ESMO-ESGO 指南分别推荐所有铂敏感复发患者和少转移复发患者选择二次细胞还原手术(sCRS)治疗。在所有三项试验中,预测完全大体切除(CGR)的标准都被用于选择接受 sCRS 的患者。没有一项试验使用疾病部位或疾病范围等手术预后因素进行分层。在计划前/事后的亚组分析中,sCRS 的结果各不相同。与单纯全身化疗相比,不完全CRS的生存率更低。即使获得了 CGR,并非所有患者都能从 sCRS 中获得相同的获益。没有任何一项试验评估了接受聚-ADP核糖聚合酶(PARP)抑制剂治疗的患者从sCRS中获益的情况。虽然 GOG-213 试验显示,使用贝伐单抗时 sCRS 无益,但并未评估贝伐单抗在 CGR 患者中的作用。在一线治疗中使用靶向疗法的情况越来越多,这将影响治疗决策和未来的临床试验设计。有关 sCRS 的新试验应根据手术预后因素对患者进行分层;仅应对 CGR 患者进行亚组分析。亮点 - 所有三项随机试验中使用的选择标准都能预测完全细胞减灭术的效果,而不能预测手术的获益 - 事后和预先指定的亚组分析表明,并非所有接受二次细胞减灭术的患者都能从中获益 - 对于接受完全大体切除术的患者,应单独进行事后和亚组分析 - 不完全细胞减灭术对生活质量和后续治疗的影响需要进一步评估 - 未来的随机试验应将疾病部位和范围等手术预后因素作为分层因素
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引用次数: 0
Ascites does not accompany pleural effusion developing under dasatinib therapy in patients with CML-CP. CML-CP患者在接受达沙替尼治疗时不会出现腹水和胸腔积液。
IF 1.8 Q2 Medicine Pub Date : 2024-02-28 eCollection Date: 2024-03-01 DOI: 10.1515/pp-2023-0016
Selin Küçükyurt, Tuğçe Eşkazan, Mesut Ayer, Burçak Kılıçkıran Avcı, İbrahim Hatemi, Ahmet Emre Eşkazan

Objectives: Pleural effusion (PE) is the most frequent pulmonary complication of dasatinib, a tyrosine kinase inhibitor (TKI). Concurrent pericardial effusions have been reported in about one-third of the cases. In this study, we aimed to investigate ascites generation in chronic-phase chronic myeloid leukemia (CML-CP) patients developing PE under dasatinib.

Methods: We conducted a cross-sectional study to evaluate whether pericardial effusion and ascites accompany PE in CML-CP patients treated with dasatinib. For this purpose, consecutive patients with CML-CP who developed PE under dasatinib therapy have been evaluated with chest X-ray, transthoracic echocardiography, and abdominal ultrasonography.

Results: There were seven patients, and the median age was 50 years (range, 31-73 years). Most of patients were male (n=5). All patients received imatinib as first-line TKI. Six patients received dasatinib following imatinib failure in second line. The median duration from dasatinib initiation to PE generation was 58 months (range, 8-135 months). Consequently, four patients had grade 1 pericardial effusion, and no patient had ascites.

Conclusions: In our small study, dasatinib-related PE was associated with low-grade pericardial effusion but no ascites. There are hypothetical explanations of this phenomenon including the simultaneous activation/inhibition of kinases; however, more research needs to be performed on this topic.

目的:胸腔积液(PE)是酪氨酸激酶抑制剂(TKI)达沙替尼最常见的肺部并发症。约有三分之一的病例并发心包积液。在这项研究中,我们旨在调查慢性期慢性髓性白血病(CML-CP)患者在服用达沙替尼后出现心包积液的腹水产生情况:我们进行了一项横断面研究,以评估接受达沙替尼治疗的慢性粒细胞白血病(CML-CP)患者在出现 PE 时是否伴有心包积液和腹水。为此,我们对连续接受达沙替尼治疗并出现PE的CML-CP患者进行了胸部X光、经胸超声心动图和腹部超声检查:共有7名患者,中位年龄为50岁(31-73岁)。大多数患者为男性(5 人)。所有患者均接受伊马替尼作为一线 TKI。6名患者在伊马替尼二线治疗失败后接受了达沙替尼治疗。从开始使用达沙替尼到产生PE的中位时间为58个月(8-135个月)。因此,4名患者出现1级心包积液,没有患者出现腹水:在我们的小型研究中,达沙替尼相关PE与低度心包积液有关,但没有腹水。对这一现象有一些假设性的解释,包括激酶的同时激活/抑制;然而,还需要对这一主题进行更多的研究。
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引用次数: 0
In vitro 3D microfluidic peritoneal metastatic colorectal cancer model for testing different oxaliplatin-based HIPEC regimens. 体外三维微流控腹膜转移性结直肠癌模型,用于测试以奥沙利铂为基础的不同 HIPEC 方案。
IF 1.8 Q2 Medicine Pub Date : 2024-02-28 eCollection Date: 2024-03-01 DOI: 10.1515/pp-2023-0033
Aras Emre Canda, Tolga Sever, Gizem Calibasi Kocal, Yasemin Basbinar, Hulya Ellidokuz

Objectives: Treatment of colorectal peritoneal metastases with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) is still evolving. Conducting a randomized trial is challenging due to the high heterogeneity in the presentation of peritoneal disease and various surgical approaches. Biological research may facilitate more rapid translation of information into clinical practice. There is an emerging need for a preclinical model to improve HIPEC treatment protocols in terms of drug doses and treatment durations. The aim of the study is to design a tool that serves as an in vitro three-dimensional (3D) microfluidic peritoneal metastatic colorectal cancer model to test the efficacy of different HIPEC treatments.

Methods: We determined the effects of current therapy options using a 3D static disease model on human colon carcinoma cell lines (HCT 116) and transforming growth factor-β1 induced epithelial-to-mesenchymal transition (EMT) HCT 116 lines at 37 °C and 42 °C for 30, 60, and 120 min. We determined oxaliplatin's half maximal inhibitory concentrations in a 3D static culture by using viability assay. Clinical practices of HIPEC were applied in the developed model.

Results: EMT-induced HCT 116 cells were less sensitive to oxaliplatin treatment compared to non-induced cells. We observed increased cytotoxicity when increasing the temperature from 37 °C to 42 °C and extending the treatment duration from 30 to 120 min. We found that 200 mg/m2 oxaliplatin administered for 120 min is the most effective HIPEC treatment option within the framework of clinic applications.

Conclusions: The tool map provide insights into creating more realistic pre-clinical tools that could be used for a patient-based drug screening.

目的:采用囊肿切除手术和腹腔热化疗(HIPEC)治疗结直肠腹膜转移瘤的方法仍在不断发展。由于腹膜疾病的表现和各种手术方法存在高度异质性,因此开展随机试验具有挑战性。生物研究有助于更快地将信息转化为临床实践。目前正需要一种临床前模型来改进 HIPEC 治疗方案的药物剂量和治疗时间。本研究旨在设计一种工具,作为体外三维(3D)微流体腹膜转移性结直肠癌模型,以测试不同 HIPEC 治疗方法的疗效:我们利用三维静态疾病模型,在 37 ℃ 和 42 ℃条件下分别持续 30、60 和 120 分钟,测定了当前治疗方案对人结肠癌细胞系(HCT 116)和转化生长因子-β1 诱导的上皮细胞向间质转化(EMT)HCT 116 细胞系的影响。我们通过活力测定法确定了三维静态培养中奥沙利铂的半数最大抑制浓度。在所开发的模型中应用了 HIPEC 的临床实践:结果:与非诱导细胞相比,EMT 诱导的 HCT 116 细胞对奥沙利铂治疗的敏感性较低。我们观察到,当温度从 37 °C 升高到 42 °C,处理时间从 30 分钟延长到 120 分钟时,细胞毒性增加。我们发现,在临床应用框架内,200 毫克/平方米奥沙利铂治疗 120 分钟是最有效的 HIPEC 治疗方案:该工具图为创建更真实的临床前工具提供了启示,可用于基于患者的药物筛选。
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引用次数: 0
Active surveillance for low-grade appendiceal mucinous neoplasm (LAMN) 低级别阑尾粘液瘤(LAMN)的主动监测
IF 1.8 Q2 Medicine Pub Date : 2023-12-29 DOI: 10.1515/pp-2023-0032
C. Mouawad, Armelle Bardier, Mathilde Wagner, S. Doat, D. Djelil, J. Fawaz, Marc Pocard
Abstract Objectives Due to the scarcity of low-grade appendiceal mucinous neoplasm (LAMN), there is an absence of systematized guidelines concerning its management, especially after incidental finding on an appendiceal specimen. In this study, we evaluate the active surveillance (AS) strategy adopted for a series of patients diagnosed with LAMN on resection specimens who were considered to have a low risk of pseudomyxoma progression. Methods Thirty patients were included between April 2014 and July 2021, with a female majority and a median follow-up period of 3.1 years. The inclusion criteria were as follows: LAMN diagnosis on appendiceal specimens, confirmed in an expert center, limited extra-appendiceal mucin resected and localized around the appendix, normal biology (CEA, CA199, CA125) and normal abdominopelvic MRI. AS included physical exam (trocar scar), biology and MRI, 6 months postoperatively, then yearly for 10 years. Results As an initial surgery, 77 % had an appendectomy as their initial intervention, 17 % had a cecectomy, and 6 % had a right colectomy. After follow-up, 87 % of patients showed no sign of disease progression by MRI, while 13 % progressed to PMP. MRI performed in the first postoperative year predicted the disease prognosis in 97 % of patients. Conclusions The AS strategy, based on MRI, is a valid option after incidental LAMN diagnosis.
摘要 目的 由于低级别阑尾粘液瘤(LAMN)很少见,因此缺乏有关其管理的系统化指南,尤其是在阑尾标本中偶然发现后。在本研究中,我们评估了一系列在切除标本中被诊断为 LAMN 的患者所采取的主动监测(AS)策略,这些患者被认为假性肌瘤恶化的风险较低。方法 2014 年 4 月至 2021 年 7 月间纳入了 30 例患者,其中女性占多数,中位随访时间为 3.1 年。纳入标准如下在专家中心确诊的阑尾标本上确诊为 LAMN,切除的阑尾外粘蛋白有限且位于阑尾周围,生物学指标(CEA、CA199、CA125)正常,腹盆腔 MRI 正常。AS 包括体格检查(套管疤痕)、生物学检查和核磁共振成像,术后 6 个月进行,之后 10 年每年进行一次。结果 77% 的患者在初次手术中接受了阑尾切除术,17% 的患者接受了结肠切除术,6% 的患者接受了右结肠切除术。随访后,87%的患者在核磁共振成像中未发现疾病进展迹象,13%的患者进展为PMP。术后第一年进行的磁共振成像可预测 97% 患者的疾病预后。结论 在偶然诊断出 LAMN 后,基于磁共振成像的 AS 策略是一种有效的选择。
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引用次数: 0
Peritoneal mestastases from rare ovarian cancer treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) 用细胞切除手术和腹腔热化疗(CRS/HIPEC)治疗罕见卵巢癌腹膜转移灶
IF 1.8 Q2 Medicine Pub Date : 2023-12-27 DOI: 10.1515/pp-2023-0019
Luis Felipe Falla-Zuniga, A. Sardi, M. King, F. Lopez-Ramirez, Philipp Barakat, C. Nieroda, T. Diaz-Montes, V. Gushchin
Abstract Objective There are limited treatment options and no consensus on the management of advanced rare ovarian malignancies. Rare ovarian malignancies can present with peritoneal metastases (PM), featuring a similar presentation to more common ovarian subtypes. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is an effective treatment for PM of non-gynecologic origin and, recently, epithelial ovarian cancer. We evaluated the feasibility of CRS/HIPEC in the management of PM from rare ovarian malignancies and report postoperative outcomes on these patients. Methods A retrospective review of a single center, prospective database (1994–2021) was performed to identify patients with rare ovarian malignancies treated with CRS/HIPEC. Clavien-Dindo 90-day morbidity/mortality and Kaplan–Meier overall (OS) and progression-free survival (PFS) were analyzed. Results Of 44 patients identified, 28 underwent CRS/HIPEC. Six were aborted due to extensive disease. Histologic subtypes included: clear cell (5/28, 17.9 %), endometrioid (5/28, 17.9 %), granulosa cell (3/28, 10.7 %), low-grade serous (6/28, 21.4 %), mesonephric (1/28, 3.6 %), mucinous (6/28, 21.4 %), and small cell (2/28, 7.1 %) carcinomas. Eight (28.6 %) patients had primary and 20 (71.4 %) had recurrent disease. Median peritoneal cancer index (PCI) was 21 (IQR: 6–29). Complete cytoreduction (<2.5 mm residual disease) was achieved in 27/28 (96.4 %). Grade III/IV complications occurred in 9/28 (32.1 %) with one (3.6 %) mortality. After a median follow-up of 65.8 months, 20 patients were alive. Five-year OS and PFS were 68.5 and 52.6 %, respectively. Conclusions In patients with PM from rare ovarian malignancies, CRS/HIPEC is feasible and has an acceptable safety profile. Longer follow-up and multicenter trials are needed.
摘要 目的 对于晚期罕见卵巢恶性肿瘤的治疗,目前治疗方案有限,且尚未达成共识。罕见卵巢恶性肿瘤可出现腹膜转移(PM),其表现与常见卵巢亚型相似。细胞切除手术和腹腔内热化疗(CRS/HIPEC)是治疗非妇科源性卵巢癌以及最近上皮性卵巢癌的有效方法。我们评估了 CRS/HIPEC 治疗罕见卵巢恶性肿瘤的可行性,并报告了这些患者的术后效果。方法 我们对单个中心的前瞻性数据库(1994-2021 年)进行了回顾性审查,以确定接受 CRS/HIPEC 治疗的罕见卵巢恶性肿瘤患者。分析了 Clavien-Dindo 90 天发病率/死亡率、Kaplan-Meier 总生存期(OS)和无进展生存期(PFS)。结果 在确定的 44 名患者中,28 人接受了 CRS/HIPEC。6例患者因病变广泛而流产。组织学亚型包括:透明细胞癌(5/28,17.9%)、类子宫内膜癌(5/28,17.9%)、颗粒细胞癌(3/28,10.7%)、低级别浆液性癌(6/28,21.4%)、间质细胞癌(1/28,3.6%)、粘液腺癌(6/28,21.4%)和小细胞癌(2/28,7.1%)。8名患者(28.6%)患有原发性疾病,20名患者(71.4%)患有复发性疾病。腹膜癌指数(PCI)中位数为 21(IQR:6-29)。27/28(96.4%)名患者实现了完全细胞减灭术(残留病灶小于 2.5 毫米)。9/28(32.1%)例出现了 III/IV 级并发症,其中 1 例(3.6%)死亡。中位随访 65.8 个月后,20 名患者存活。五年的OS和PFS分别为68.5%和52.6%。结论 对于罕见卵巢恶性肿瘤 PM 患者,CRS/HIPEC 是可行的,其安全性也是可以接受的。需要进行更长时间的随访和多中心试验。
{"title":"Peritoneal mestastases from rare ovarian cancer treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC)","authors":"Luis Felipe Falla-Zuniga, A. Sardi, M. King, F. Lopez-Ramirez, Philipp Barakat, C. Nieroda, T. Diaz-Montes, V. Gushchin","doi":"10.1515/pp-2023-0019","DOIUrl":"https://doi.org/10.1515/pp-2023-0019","url":null,"abstract":"Abstract Objective There are limited treatment options and no consensus on the management of advanced rare ovarian malignancies. Rare ovarian malignancies can present with peritoneal metastases (PM), featuring a similar presentation to more common ovarian subtypes. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is an effective treatment for PM of non-gynecologic origin and, recently, epithelial ovarian cancer. We evaluated the feasibility of CRS/HIPEC in the management of PM from rare ovarian malignancies and report postoperative outcomes on these patients. Methods A retrospective review of a single center, prospective database (1994–2021) was performed to identify patients with rare ovarian malignancies treated with CRS/HIPEC. Clavien-Dindo 90-day morbidity/mortality and Kaplan–Meier overall (OS) and progression-free survival (PFS) were analyzed. Results Of 44 patients identified, 28 underwent CRS/HIPEC. Six were aborted due to extensive disease. Histologic subtypes included: clear cell (5/28, 17.9 %), endometrioid (5/28, 17.9 %), granulosa cell (3/28, 10.7 %), low-grade serous (6/28, 21.4 %), mesonephric (1/28, 3.6 %), mucinous (6/28, 21.4 %), and small cell (2/28, 7.1 %) carcinomas. Eight (28.6 %) patients had primary and 20 (71.4 %) had recurrent disease. Median peritoneal cancer index (PCI) was 21 (IQR: 6–29). Complete cytoreduction (<2.5 mm residual disease) was achieved in 27/28 (96.4 %). Grade III/IV complications occurred in 9/28 (32.1 %) with one (3.6 %) mortality. After a median follow-up of 65.8 months, 20 patients were alive. Five-year OS and PFS were 68.5 and 52.6 %, respectively. Conclusions In patients with PM from rare ovarian malignancies, CRS/HIPEC is feasible and has an acceptable safety profile. Longer follow-up and multicenter trials are needed.","PeriodicalId":20231,"journal":{"name":"Pleura and Peritoneum","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139153728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Implementation of ERAS guidelines in patients undergoing CRS and HIPEC: need for multicentre trial 在接受 CRS 和 HIPEC 治疗的患者中实施 ERAS 指南:需要进行多中心试验
IF 1.8 Q2 Medicine Pub Date : 2023-12-20 DOI: 10.1515/pp-2023-0022
C. Iavazzo, I. Gkegkes, J. Spiliotis
{"title":"Implementation of ERAS guidelines in patients undergoing CRS and HIPEC: need for multicentre trial","authors":"C. Iavazzo, I. Gkegkes, J. Spiliotis","doi":"10.1515/pp-2023-0022","DOIUrl":"https://doi.org/10.1515/pp-2023-0022","url":null,"abstract":"","PeriodicalId":20231,"journal":{"name":"Pleura and Peritoneum","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138954045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Second annual report from the ISSPP PIPAC database ISSPP PIPAC 数据库第二次年度报告
IF 1.8 Q2 Medicine Pub Date : 2023-12-13 DOI: 10.1515/pp-2023-0047
Michael Bau Mortensen, Francesco Casella, Özgül Düzgün, Olivier Glehen, Peter Hewett, Martin Hübner, Magnus Skov Jørgensen, Alfred Königsrainer, Miguel Marin, M. Pocard, Günther Rezniczek, Jimmy So, C. Fristrup
Abstract Objectives To monitor the results of PIPAC directed therapy based on data from the International Society for the Study of the Pleura and Peritoneum (ISSPP) PIPAC database. Methods Analysis of data from patients entered between June 15th, 2020, and February 28th, 2023. Results Twelve centers reported 2,456 PIPAC procedures in 809 patients (median 2, range 1–18) with peritoneal metastasis (PM) from different primary tumors. Approximately 90 % had systemic chemotherapy prior to PIPAC. Twenty-eight percent were treated in prospective protocols. Overall non-access rate was 3.5 %. Concomitant surgical procedures were performed during PIPAC in 1.6 % of the patients. Median length of stay was 2 days. A total of 95 surgical complications were recorded, but only 22 % of these were graded ≥3b. Seventeen-hundred-and-three adverse events were noted, and 8 % were classified ≥3. The rate of complete or major histological response (peritoneal regression grade score, PRGS≤2) increased between the first and the third PIPAC in the group of patients who were evaluated by PRGS, and a PRGS ≤2 or a reduction of the mean PRGS of at least 1 between first and third PIPAC were observed in 80 %. Disease progression (50 %) or technical issues (19 %) were the most important reasons for stopping PIPAC treatment. Median overall survival from first PIPAC directed treatment varied from 10.7 months (CI 8.7–12.5) in gastric cancer to 27.1 months (16.4–50.5) in mesothelioma. Conclusions The ISSPP PIPAC database provides substantial real-world data supporting the use of PIPAC directed therapy in patients with PM from different primary tumors.
目的根据国际胸膜和腹膜研究学会(ISSPP) PIPAC数据库的数据,监测PIPAC定向治疗的结果。方法分析2020年6月15日至2023年2月28日期间入院的患者数据。结果12个中心报告了809例不同原发肿瘤腹膜转移(PM)患者的2456例PIPAC手术(中位数2例,范围1-18例)。大约90% %在PIPAC之前进行了全身化疗。28%的患者接受前瞻性治疗。总体非访问率为3.5 %。1.6 %的患者在PIPAC期间进行了伴随手术。中位住院时间为2天。共记录了95例手术并发症,但其中只有22% %分级≥3b。不良事件1703例,8 %分级≥3级。在接受PRGS评估的患者组中,第一次和第三次PIPAC之间的完全或主要组织学缓解率(腹膜消退等级评分,PRGS≤2)增加,PRGS≤2或第一次和第三次PIPAC之间平均PRGS降低至少1的比例为80% %。疾病进展(50% %)或技术问题(19% %)是停止PIPAC治疗的最重要原因。首次PIPAC治疗的中位总生存期从胃癌的10.7个月(CI 8.7-12.5)到间皮瘤的27.1个月(CI 16.4-50.5)不等。ISSPP PIPAC数据库提供了大量的真实数据,支持PIPAC指导治疗来自不同原发肿瘤的PM患者。
{"title":"Second annual report from the ISSPP PIPAC database","authors":"Michael Bau Mortensen, Francesco Casella, Özgül Düzgün, Olivier Glehen, Peter Hewett, Martin Hübner, Magnus Skov Jørgensen, Alfred Königsrainer, Miguel Marin, M. Pocard, Günther Rezniczek, Jimmy So, C. Fristrup","doi":"10.1515/pp-2023-0047","DOIUrl":"https://doi.org/10.1515/pp-2023-0047","url":null,"abstract":"Abstract Objectives To monitor the results of PIPAC directed therapy based on data from the International Society for the Study of the Pleura and Peritoneum (ISSPP) PIPAC database. Methods Analysis of data from patients entered between June 15th, 2020, and February 28th, 2023. Results Twelve centers reported 2,456 PIPAC procedures in 809 patients (median 2, range 1–18) with peritoneal metastasis (PM) from different primary tumors. Approximately 90 % had systemic chemotherapy prior to PIPAC. Twenty-eight percent were treated in prospective protocols. Overall non-access rate was 3.5 %. Concomitant surgical procedures were performed during PIPAC in 1.6 % of the patients. Median length of stay was 2 days. A total of 95 surgical complications were recorded, but only 22 % of these were graded ≥3b. Seventeen-hundred-and-three adverse events were noted, and 8 % were classified ≥3. The rate of complete or major histological response (peritoneal regression grade score, PRGS≤2) increased between the first and the third PIPAC in the group of patients who were evaluated by PRGS, and a PRGS ≤2 or a reduction of the mean PRGS of at least 1 between first and third PIPAC were observed in 80 %. Disease progression (50 %) or technical issues (19 %) were the most important reasons for stopping PIPAC treatment. Median overall survival from first PIPAC directed treatment varied from 10.7 months (CI 8.7–12.5) in gastric cancer to 27.1 months (16.4–50.5) in mesothelioma. Conclusions The ISSPP PIPAC database provides substantial real-world data supporting the use of PIPAC directed therapy in patients with PM from different primary tumors.","PeriodicalId":20231,"journal":{"name":"Pleura and Peritoneum","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138633039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
What is long-term survival in patients with peritoneal metastasis from gastric, pancreatic, or colorectal cancer? A study of patients treated with systemic chemotherapy and pressurized intraperitoneal aerosol chemotherapy (PIPAC) 胃癌、胰腺癌或结直肠癌腹膜转移患者的长期生存率如何?对接受全身化疗和腹腔内加压气溶胶化疗 (PIPAC) 患者的研究
IF 1.8 Q2 Medicine Pub Date : 2023-12-01 DOI: 10.1515/pp-2023-0038
Charlotte G. Kryh-Jensen, C. Fristrup, Alan P. Ainsworth, S. Detlefsen, Michael B. Mortensen, Per Pfeiffer, L. Tarpgaard, M. Graversen
Abstract Objectives A definition of long-term survival (LTS) in patients with peritoneal metastasis (PM) from gastric cancer (GC), pancreatic cancer (PC) or colorectal cancer (CRC) treated with systemic chemotherapy and pressurized intraperitoneal aerosol chemotherapy (PIPAC) is lacking. We aimed to define LTS and investigate characteristics and treatment response in patients who reached LTS in data from two prospective trials. Methods Retrospective study of patients with GC-, PC-, or CRC-PM from the prospective PIPAC-OPC1 and PIPAC-OPC2 studies. The definition of LTS was based on published systematic reviews and randomized controlled trials. LTS was defined at the time point where 25 % of the patients were alive in these studies. Histology based response was evaluated by the mean Peritoneal Regression Grading Score (PRGS) using biopsies obtained prior to PIPAC 3, and defined by a mean PRGS of ≤2.0 or a decrease of mean PRGS of ≥1, compared to baseline. Results LTS was defined at 21 (GC), 15 (PC), and 24 (CRC) months. Fifty-one (47.2 %) patients (nine GC, 17 PC, 25 CRC) reached LTS calculated from the date of PM diagnosis. All but one received palliative chemotherapy before PIPAC, and 37 % received bidirectional treatment. More than 90 % of the LTS patients had response according to PRGS. The mOS from PIPAC 1 was 23.3, 12.4, and 28.5 months for GC, PC, and CRC LTS patients. Conclusions Patients with PM from GC, PC, and CRC treated with systemic chemotherapy and PIPAC can reach LTS and most show histological response. Causality must be further investigated.
摘要 目的 缺乏对胃癌(GC)、胰腺癌(PC)或结直肠癌(CRC)腹膜转移(PM)患者接受全身化疗和加压腹腔内气溶胶化疗(PIPAC)后长期生存(LTS)的定义。我们旨在定义LTS,并调查两项前瞻性试验数据中达到LTS的患者的特征和治疗反应。方法 对前瞻性 PIPAC-OPC1 和 PIPAC-OPC2 研究中的 GC、PC 或 CRC-PM 患者进行回顾性研究。LTS 的定义基于已发表的系统综述和随机对照试验。在这些研究中,LTS 的定义为 25% 的患者存活的时间点。组织学反应根据 PIPAC 3 之前获得的活组织切片的平均腹膜回归分级评分(PRGS)进行评估,平均 PRGS 与基线相比≤2.0 或平均 PRGS 降低≥1。结果 LTS 的定义时间分别为 21 个月(GC)、15 个月(PC)和 24 个月(CRC)。51例(47.2%)患者(9 例 GC、17 例 PC、25 例 CRC)从 PM 诊断之日起计算达到了 LTS。除一名患者外,其他患者均在 PIPAC 前接受了姑息化疗,37% 的患者接受了双向治疗。根据 PRGS,90% 以上的 LTS 患者有反应。GC、PC 和 CRC LTS 患者自 PIPAC 1 起的生存期分别为 23.3 个月、12.4 个月和 28.5 个月。结论 接受全身化疗和 PIPAC 治疗的 GC、PC 和 CRC PM 患者可达到 LTS,且大多数患者表现出组织学反应。其因果关系有待进一步研究。
{"title":"What is long-term survival in patients with peritoneal metastasis from gastric, pancreatic, or colorectal cancer? A study of patients treated with systemic chemotherapy and pressurized intraperitoneal aerosol chemotherapy (PIPAC)","authors":"Charlotte G. Kryh-Jensen, C. Fristrup, Alan P. Ainsworth, S. Detlefsen, Michael B. Mortensen, Per Pfeiffer, L. Tarpgaard, M. Graversen","doi":"10.1515/pp-2023-0038","DOIUrl":"https://doi.org/10.1515/pp-2023-0038","url":null,"abstract":"Abstract Objectives A definition of long-term survival (LTS) in patients with peritoneal metastasis (PM) from gastric cancer (GC), pancreatic cancer (PC) or colorectal cancer (CRC) treated with systemic chemotherapy and pressurized intraperitoneal aerosol chemotherapy (PIPAC) is lacking. We aimed to define LTS and investigate characteristics and treatment response in patients who reached LTS in data from two prospective trials. Methods Retrospective study of patients with GC-, PC-, or CRC-PM from the prospective PIPAC-OPC1 and PIPAC-OPC2 studies. The definition of LTS was based on published systematic reviews and randomized controlled trials. LTS was defined at the time point where 25 % of the patients were alive in these studies. Histology based response was evaluated by the mean Peritoneal Regression Grading Score (PRGS) using biopsies obtained prior to PIPAC 3, and defined by a mean PRGS of ≤2.0 or a decrease of mean PRGS of ≥1, compared to baseline. Results LTS was defined at 21 (GC), 15 (PC), and 24 (CRC) months. Fifty-one (47.2 %) patients (nine GC, 17 PC, 25 CRC) reached LTS calculated from the date of PM diagnosis. All but one received palliative chemotherapy before PIPAC, and 37 % received bidirectional treatment. More than 90 % of the LTS patients had response according to PRGS. The mOS from PIPAC 1 was 23.3, 12.4, and 28.5 months for GC, PC, and CRC LTS patients. Conclusions Patients with PM from GC, PC, and CRC treated with systemic chemotherapy and PIPAC can reach LTS and most show histological response. Causality must be further investigated.","PeriodicalId":20231,"journal":{"name":"Pleura and Peritoneum","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139019425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Genital cutaneous necrosis: a delayed sequela of intraperitoneal Mitomycin-c 生殖器皮肤坏死:腹膜内注射丝裂霉素c的延迟后遗症
Q2 Medicine Pub Date : 2023-10-13 DOI: 10.1515/pp-2023-0021
Sage A. Vincent, Meghan Maceyko, Peter J. Altshuler, Zachary Davis, J. Ryan Mark, Paul H. Chung, Wilbur B. Bowne
{"title":"Genital cutaneous necrosis: a delayed sequela of intraperitoneal Mitomycin-c","authors":"Sage A. Vincent, Meghan Maceyko, Peter J. Altshuler, Zachary Davis, J. Ryan Mark, Paul H. Chung, Wilbur B. Bowne","doi":"10.1515/pp-2023-0021","DOIUrl":"https://doi.org/10.1515/pp-2023-0021","url":null,"abstract":"","PeriodicalId":20231,"journal":{"name":"Pleura and Peritoneum","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135805251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
UK trial of pressurised intraperitoneal aerosolised chemotherapy (PIPAC) with oxaliplatin for colorectal cancer peritoneal metastases (NCT03868228). 腹腔内加压气溶胶化疗(PIPAC)与奥沙利铂治疗结直肠癌腹膜转移的英国试验(NCT03868228)。
IF 1.8 Q2 Medicine Pub Date : 2023-09-11 eCollection Date: 2023-12-01 DOI: 10.1515/pp-2023-0008
Peter Kyle, Kitrick Perry, Anne Moutadjer, Nicholas Gilfillan, Rosalind Webb, Dolan Basak, Paul Ziprin, Dominic Blunt, James Burn, Katherine Van Ree, Antoni Sergot, Jamie Murphy

Objectives: This is the first UK trial of pressurised intraperitoneal aerosolised chemotherapy (PIPAC) for colorectal cancer peritoneal metastases. This trial aimed to assess the impact of PIPAC in combination with standard of care systemic treatment on: progression free survival (PFS); quality of life (QoL); and short-term complications. In addition, this trial set out to demonstrate that PIPAC can be performed safely in operating theatres within a National Health Service (NHS) setting.

Methods: Single-centre clinical trial with prospective data collection for patients undergoing 8-weekly PIPAC with oxaliplatin at 92 mg/m2 from January 2019 till January 2022. Progression free survival was assessed using peritoneal carcinomatosis index (PCI) by CT scans and laparoscopy. Quality of life was assessed by EORTC QLQ-C30 questionnaire. Adverse events were recorded using CTCAE.

Results: Five patients underwent a total of ten PIPAC administrations (median 2, range 1-4). Median PFS was 6.0 months. QoL was maintained across repeat PIPAC procedures but a decrease in social functioning and increased fatigue were evident. Three incidences of grade 3 adverse events occurred but PIPAC was well tolerated.

Conclusions: The presented data demonstrates that PIPAC is feasible and can be safely delivered within the NHS for patients with colorectal cancer peritoneal metastases, but caution must also be exercised given a risk of adverse events. Systemic chemotherapy can be safely administered at a different unit to the PIPAC procedure if both groups have clear lines of communication and timely data sharing.

试验目的:这是英国首例针对结直肠癌腹膜转移的腹腔内加压雾化化疗(PIPAC)试验。该试验旨在评估 PIPAC 与标准护理系统治疗相结合对以下方面的影响:无进展生存期(PFS)、生活质量(QoL)和短期并发症。此外,该试验还旨在证明 PIPAC 可以在国家医疗服务体系(NHS)的手术室安全进行:2019年1月至2022年1月期间,对接受8周PIPAC治疗的患者进行前瞻性数据收集,奥沙利铂的剂量为92毫克/平方米。通过CT扫描和腹腔镜检查,使用腹膜癌肿指数(PCI)评估无进展生存期。生活质量通过 EORTC QLQ-C30 问卷进行评估。使用CTCAE记录不良事件:5名患者共接受了10次PIPAC治疗(中位2次,范围1-4次)。中位 PFS 为 6.0 个月。在重复PIPAC治疗过程中,患者的生活质量得以保持,但社会功能明显下降,疲劳感增加。发生了3例3级不良反应,但PIPAC的耐受性良好:所提供的数据表明,PIPAC 是可行的,可以在国家医疗服务系统内安全地用于结直肠癌腹膜转移患者,但考虑到不良事件的风险,也必须谨慎行事。如果双方有明确的沟通渠道和及时的数据共享,系统化疗可在与 PIPAC 程序不同的单位安全进行。
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Pleura and Peritoneum
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