HJBR Sep/Oct 2022

56 SEP / OCT 2022 I  HEALTHCARE JOURNAL OF BATON ROUGE ONCOLOGY surgery alone and did not result in higher rates of side effects when compared to cy- toreductive surgery alone. There are other studies showing benefit for CRS/HIPEC for recurrent epithelial ovarian cancer, although this is a topic of ongoing research with con- flicting results across different studies, which can be attributed to different selection cri- teria and chemotherapeutic agents across different studies. In very selected cases, and ideally in the context of a clinical trial, highly selected pa- tients with gastric adenocarcinoma (non-sig- net ring) and limited peritoneal metastasis (PCI score of less than seven) may benefit from HIPEC. Ongoing clinical trials are in- vestigating the role of HIPEC in this scenario, following promising phase I and II trials in which HIPEC was used to convert cytology- positive advanced gastric cancer into cytol- ogy-negative followed by surgical resection. CONCLUSION Cytoreductive surgery and HIPEC can be a treatment option for selected patients with limited colorectal peritoneal metasta- sis, appendiceal mucinous tumors, recurrent epithelial ovarian cancer, primary peritoneal mesothelioma, and in highly selected gas- tric cancer patients with limited peritoneal metastasis n REFERENCES 1 Stewart, J.H. 4th; Blazer, D.G.; Calderon, M.J.G.; et al. “The Evolving Management of Peritoneal Sur- face Malignancies.” Current Problems in Surgery 58, no. 4 (April 2021): 100860. doi: 10.1016/ j.cp - surg.2020.100860 2 Istl, A.C.; Gage, M.M.; Esquivel, J.; et al. “Man- agement of Low-Grade Appendiceal Mucinous Neoplasms (LAMN): An International Survey of Surgeons Performing CRS and HIPEC.” Annals of Surgical Oncology 28, no. 7 ( July 2021): 3831- 3837. doi: 10.1245/s10434-020-09312-w 3 Verwaal, V.J.; Bruin, S.; Boot, H.; et al. “8-year follow-up of randomized trial: cytoreduction and hyperthermic intraperitoneal chemotherapy ver- sus systemic chemotherapy in patients with peri- toneal carcinomatosis of colorectal cancer.” An- nals of Surgical Oncology 15, no. 9 (Sept. 2008): 2426–2432. 4 Quénet, F.; Elias, D.; UNICANCER-GI Group and BIG Renape Group; et al. “Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy versus cytoreductive surgery alone for colorectal peritoneal metastases (PRODIGE 7): a multicentre, randomised, open-label, phase 3 trial.” The Lan- cet. Oncology 22, no. 2 (Feb. 2021): 256-266. doi: 10.1016/S1470-2045(20)30599-4 5 Badgwell, B.; Blum, M.; Das, P.; et al. “Lessons learned from a phase II clinical trial of laparoscop- ic HIPEC for gastric cancer.” Surgical Endoscopy 32, no. 1 (Jan. 2018): 512. doi: 10.1007/s00464-017- 5668-9 6 van Driel WJ, Koole SN, et al. “Hyperthermic In- traperitoneal Chemotherapy in Ovarian Cancer.” New England Journal of Medicine 378, no. 3 (Jan. 18, 2018): 230-240. doi: 10.1056/NEJMoa1708618. As part of the Surgeons Group of Baton Rouge at Our Lady of the Lake Regional Medical Center and Can- cer Institute, MohammadAl Efishat, MD, is a surgical oncologist and pancreatic and hepatobiliary surgeon, treating conditions of the pancreas, liver, gallbladder, and bile duct.He also treats abdominal tumors, includ- ing those with peritoneal carcinomatosis, sarcoma, melanoma, and breast cancer. Al Efishat is a clinical assistant professor at LSU School of Medicine. in the surgical oncology space regarding the benefit of HIPEC in colorectal metastasis; this study was a randomized, open-label, phase III trial at 17 cancer centers in France, where 265 patients were randomly assigned to cytoreductive surgery plus HIPEC group or cytoreductive surgery alone, and it failed to show an overall survival difference. But the most staggering finding was the median survival of around 41 months in each arm, and 40% 5-year survival, underscoring the role of complete oncologic cytoreductive surgery in peritoneal metastasis. Albeit this trial has been heavily criticized given that it was underpowered, overestimated the antici- pated improvement in median survival, and utilized oxaliplatin for 30 minutes in lieu of the commonly used regimen of mitomycin C for 90 minutes. Importantly, there are no studies demonstrating the effectiveness of intraperitoneal oxaliplatin to start with. And thus, investigators in Europe and the Unit- ed States are now conducting a randomized controlled trial to evaluate the role of addi- tion of HIPEC to CRS in colorectal peritoneal metastasis using hyperthermic mitomycin C for 90 minutes. In a recent randomized controlled trial among women with advanced ovarian can- cer, HIPEC plus complete interval cytoreduc- tive surgery resulted in longer recurrence- free survival and more overall survival than “... the ‘ideal’ patient for CRS/HIPEC is one with low-grade appendiceal neoplasm (LAMN) with peritoneal mucinous metastasis, or pseudomyxoma peritonei, which is now referred to as diffuse peritoneal mucinosis (DPAM).”