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Combined Nabpaclitaxel pressurized intraPeritoneal aerosol chemotherapy with systemic Nabpaclitaxel-Gemcitabine chemotherapy for pancreatic cancer peritoneal metastases: protocol of single-arm, open-label, phase II trial (Nab-PIPAC trial). 纳布紫杉醇腹腔内加压气溶胶化疗与纳布紫杉醇-吉西他滨全身化疗联合治疗胰腺癌腹膜转移:单臂、开放标签 II 期试验方案(Nab-PIPAC 试验)。
IF 1.4 Q4 ONCOLOGY Pub Date : 2024-11-06 eCollection Date: 2024-09-01 DOI: 10.1515/pp-2024-0010
Andrea Di Giorgio, Federica Ferracci, Cinzia Bagalà, Carmine Carbone, Lisa Salvatore, Antonia Strippoli, Miriam Attalla El Halabieh, Carlo Abatini, Sergio Alfieri, Fabio Pacelli, Giampaolo Tortora

Objectives: Current therapies show limited efficacy against peritoneal metastases (PM) from pancreatic cancer. Pressurized intra-peritoneal aerosol chemotherapy (PIPAC) has emerged as a novel intraperitoneal drug delivery method. Recently, a dose-escalation study identified the safe dose of Nabpaclitaxel for PIPAC administration, an ideal intraperitoneal chemotherapy agent against pancreatic cancer. Combining systemic NabPaclitaxel-Gemcitabine with NabPaclitaxel-PIPAC may enhance disease control in pancreatic cancer patients with PM.

Methods: The Nab-PIPAC trial is a single-center, prospective, open-label, phase II study (ClinicalTrials.gov identifier: NCT05371223). Its primary goal is to evaluate the antitumor activity of the combined treatment based on Disease Control Rate (DCR) using RECISTv.1.1 criteria. Secondary objectives include feasibility, safety, pathological response, progression-free and overall survival, nutritional status, quality of life, pharmacokinetics of NabPaclitaxel-PIPAC, and PM molecular evolution via translational research. The treatment protocol consists of three courses, each with two cycles of intravenous NabPaclitaxel-Gemcitabine and one cycle of NabPaclitaxel-PIPAC, with standard metastatic pancreatic cancer doses for the former and 112.5 mg/m2 for the latter. Sample size follows Simon's two-stage design: 12 patients in stage one and 26 in stage two (80 % power, 0.1 alpha).

Results: Partial results will be available after first stage enrollment.

Conclusions: This trial aims to determine the antitumor efficacy and safety of combining NabPaclitaxel-PIPAC with systemic NabPaclitaxel-Gemcitabine in pancreatic cancer patients with PM.

目的:目前的疗法对胰腺癌腹膜转移(PM)的疗效有限。腹腔内加压气溶胶化疗(PIPAC)已成为一种新型的腹腔内给药方法。最近,一项剂量递增研究确定了纳帕紫杉醇(Nabpaclitaxel)在PIPAC给药中的安全剂量,这是一种理想的胰腺癌腹腔内化疗药物。将全身用药纳布紫杉醇-吉西他滨与纳布紫杉醇-PIPAC联合使用,可提高胰腺癌患者的疾病控制率:Nab-PIPAC试验是一项单中心、前瞻性、开放标签的II期研究(ClinicalTrials.gov标识符:NCT05371223)。其主要目标是根据疾病控制率(DCR),采用 RECISTv.1.1 标准评估联合治疗的抗肿瘤活性。次要目标包括可行性、安全性、病理反应、无进展生存期和总生存期、营养状况、生活质量、NabPaclitaxel-PIPAC的药代动力学以及通过转化研究进行的PM分子演化。治疗方案包括三个疗程,每个疗程静脉注射两个周期的NabPaclitaxel-Gemcitabine和一个周期的NabPaclitaxel-PIPAC,前者的标准转移性胰腺癌剂量为112.5 mg/m2,后者的标准转移性胰腺癌剂量为112.5 mg/m2。样本量采用西蒙的两阶段设计:第一阶段 12 名患者,第二阶段 26 名患者(80% 功率,0.1 α):部分结果将在第一阶段注册后公布:本试验旨在确定将 NabPaclitaxel-PIPAC 与全身用 NabPaclitaxel-Gemcitabine 联合治疗胰腺癌 PM 患者的抗肿瘤疗效和安全性。
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引用次数: 0
Thromboelastogram changes are associated with postoperative complications after cytoreductive surgery. 血栓弹力图的变化与细胞再生手术后的并发症有关。
IF 1.4 Q4 ONCOLOGY Pub Date : 2024-10-18 eCollection Date: 2024-09-01 DOI: 10.1515/pp-2023-0018
Noam Goder, Lilach Zac, Nadav Nevo, Fabian Gerstenhaber, Or Goren, Barak Cohen, Idit Matot, Guy Lahat, Eran Nizri

Objectives: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is used to treat peritoneal surface malignancies. However, surgical morbidity is high, and prediction of severe postoperative complications (SPC) is limited. We hypothesized that the changes in thromboelastogram (TEG) values following CRS could be associated with SPC.

Methods: We retrospectively analyzed a cohort of CRS and HIPEC patients who had TEG measured before and after CRS. Clinical and postoperative data were retrieved from a prospectively maintained database.

Results: Our 37-patient cohort was comprised of 24 men and 13 women with an age (median, [interquartile range, IQR]) 55 (47-65) years, of whom six had SPC. The ones with SPC did not differ from the others in age, sex, tumor histology or preoperative chemotherapy. The extent of surgery as measured by the peritoneal carcinomatosis index and the number of organs resected was comparable between SPC group vs. no SPC [9 (3-10.5) vs. 9 (5-14), p=1.0; 2 (0.75-2.25) vs. 2 (1-3), p=0.88, respectively]. The TEG parameters showed increased R- and K- time for the patients with SPC compared to those without (6 ± 3.89 vs. 4.05 ± 1.24, p=0.01; 1.65 ± 0.63 vs. 1.25 ± 0.4, p=0.03, respectively). The TEG values were significantly associated with SPC in the multivariable analysis (odds ratio=1.53, p=0.05).

Conclusions: TEG changes are associated with SPC. Intra-operative markers of SPC could guide intraoperative decisions, such as stool diversion and postoperative triage of patients to an appropriate level of care.

目的:腹腔镜手术(CRS)和腹腔内热化疗(HIPEC)用于治疗腹膜表面恶性肿瘤。然而,手术的发病率很高,对术后严重并发症(SPC)的预测也很有限。我们假设 CRS 术后血栓弹力图(TEG)值的变化可能与 SPC 相关:我们回顾性分析了一组在 CRS 前后测量过 TEG 的 CRS 和 HIPEC 患者。临床和术后数据均来自一个前瞻性数据库:我们的 37 名患者队列中有 24 名男性和 13 名女性,年龄(中位数,[四分位数间距,IQR])55(47-65)岁,其中 6 人患有 SPC。SPC患者在年龄、性别、肿瘤组织学或术前化疗方面与其他患者没有差异。以腹膜癌变指数和切除器官数量衡量的手术范围,SPC 组与未 SPC 组相当[分别为 9 (3-10.5) vs. 9 (5-14),p=1.0;2 (0.75-2.25) vs. 2 (1-3),p=0.88]。TEG参数显示,SPC患者的R-和K-时间比非SPC患者增加(分别为6 ± 3.89 vs. 4.05 ± 1.24,p=0.01;1.65 ± 0.63 vs. 1.25 ± 0.4,p=0.03)。在多变量分析中,TEG值与SPC明显相关(几率比=1.53,P=0.05):结论:TEG变化与SPC相关。SPC的术中指标可指导术中决策,如粪便转运和术后将患者分流到适当的护理级别。
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引用次数: 0
Impact of laparoscopic ultrasound during PIPAC directed treatment of unresectable peritoneal metastasis. 在对无法切除的腹膜转移瘤进行 PIPAC 指导治疗期间,腹腔镜超声波的影响。
IF 1.4 Q4 ONCOLOGY Pub Date : 2024-09-06 eCollection Date: 2024-09-01 DOI: 10.1515/pp-2024-0007
Magnus S Jørgensen, Alan P Ainsworth, Claus W Fristrup, Michael B Mortensen, Martin Graversen

Objectives: Laparoscopic ultrasound (LUS) combines both laparoscopy and ultrasound imaging of the peritoneum liver and retroperitoneum. LUS has not been described in treatments with pressurized intraperitoneal aerosol chemotherapy (PIPAC). We present our experience with LUS in patients undergoing PIPAC.

Methods: Retrospective study of LUS findings from the prospective PIPAC-OPC2 trial. Main outcome was changes in overall treatment strategy due to LUS findings.

Results: PIPAC-OPC2 included 143 patients of which 33 patients were treated with electrostatic precipitation PIPAC. Nine patients were excluded due to primary non-access. During PIPAC 1, LUS was performed in 112 of 134 (84 %) PIPAC procedures and changed overall treatment strategy in one patient due to detection of multiple liver metastases unseen by baseline CT. During PIPAC 2 and 3 LUS was performed in 59 of 104 (57 %) and 42 of 78 (54 %) PIPAC procedures, respectively. Throughout PIPAC 1-3, LUS also detected pathological lymph nodes in 16 patients, and focal liver lesions in another four patients of uncertain origin. No further examinations were performed in these patients, and the overall treatment strategy was not changed according to the PIPAC-OPC2 protocol. One patient had a splenic capsule rupture related to the LUS itself. This was managed conservatively.

Conclusions: LUS may be safely performed during PIPAC. However, LUS has limited clinical impact in patients scheduled for PIPAC, and cannot be recommended as a routine procedure when performing PIPAC.

目的:腹腔镜超声(LUS)结合了腹腔镜检查和腹膜肝脏及腹膜后超声成像。腹腔镜超声检查在加压腹腔内气溶胶化疗(PIPAC)中的应用尚未见报道。我们将介绍在接受 PIPAC 治疗的患者中进行 LUS 的经验:方法:对前瞻性 PIPAC-OPC2 试验的 LUS 结果进行回顾性研究。结果:PIPAC-OPC2试验纳入的患者中,有4名患者接受了LUS治疗:PIPAC-OPC2包括143名患者,其中33名患者接受了静电沉淀PIPAC治疗。9名患者因原发性未入院而被排除在外。在 PIPAC 1 期间,对 134 例 PIPAC 手术中的 112 例(84%)进行了 LUS,并对一名患者改变了整体治疗策略,原因是发现了基线 CT 未见的多个肝转移灶。在 PIPAC 2 和 3 期间,分别在 104 例 PIPAC 手术中的 59 例(57%)和 78 例 PIPAC 手术中的 42 例(54%)进行了 LUS。在整个 PIPAC 1-3 期间,LUS 还检测到 16 例患者的病理淋巴结,以及另外 4 例来源不明的肝脏病灶。这些患者没有接受进一步检查,总体治疗策略也没有根据 PIPAC-OPC2 方案进行改变。一名患者的脾囊破裂与 LUS 本身有关。结论:结论:在 PIPAC 期间可以安全地进行 LUS。然而,LUS 对计划进行 PIPAC 的患者的临床影响有限,因此不能推荐在进行 PIPAC 时将其作为常规手术。
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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 Q4 ONCOLOGY 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 Q4 ONCOLOGY 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。
{"title":"<i>In vitro</i> 3D microfluidic peritoneal metastatic colorectal cancer model for testing different oxaliplatin-based HIPEC regimens.","authors":"Aras Emre Canda, Tolga Sever, Gizem Calibasi Kocal, Yasemin Basbinar, Hulya Ellidokuz","doi":"10.1515/pp-2023-0033","DOIUrl":"10.1515/pp-2023-0033","url":null,"abstract":"<p><strong>Objectives: </strong>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 <i>in vitro</i> three-dimensional (3D) microfluidic peritoneal metastatic colorectal cancer model to test the efficacy of different HIPEC treatments.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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/m<sup>2</sup> oxaliplatin administered for 120 min is the most effective HIPEC treatment option within the framework of clinic applications.</p><p><strong>Conclusions: </strong>The tool map provide insights into creating more realistic pre-clinical tools that could be used for a patient-based drug screening.</p>","PeriodicalId":20231,"journal":{"name":"Pleura and Peritoneum","volume":"9 1","pages":"23-29"},"PeriodicalIF":1.8,"publicationDate":"2024-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10980980/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140336588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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 Q4 ONCOLOGY 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。
{"title":"Active surveillance for low-grade appendiceal mucinous neoplasm (LAMN)","authors":"C. Mouawad, Armelle Bardier, Mathilde Wagner, S. Doat, D. Djelil, J. Fawaz, Marc Pocard","doi":"10.1515/pp-2023-0032","DOIUrl":"https://doi.org/10.1515/pp-2023-0032","url":null,"abstract":"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.","PeriodicalId":20231,"journal":{"name":"Pleura and Peritoneum","volume":"90 5","pages":""},"PeriodicalIF":1.8,"publicationDate":"2023-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139147102","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
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 Q4 ONCOLOGY 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。
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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 Q4 ONCOLOGY 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":"111 21","pages":""},"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 Q4 ONCOLOGY 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":"49 3","pages":""},"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 Q4 ONCOLOGY 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。
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Pleura and Peritoneum
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