V Kepenekian1, D Elias2, G Passot1, E Mery3, D Goere2, D Delroeux4, F Quenet5, G Ferron6, D Pezet7, J M Guilloit8, P Meeus9, M Pocard10, J M Bereder11, K Abboud12, C Arvieux13, C Brigand14, F Marchal15, J M Classe16, G Lorimier17, C De Chaisemartin18, F Guyon19, P Mariani20, P Ortega-Deballon21, S Isaac22, C Maurice23, F N Gilly1, O Glehen24. 1. Department of Digestive Surgery, Lyon-Sud University Hospital, EMR 3738, Lyon 1 University, Lyon, France. 2. Department of Surgical Oncology, Gustave Roussy, Cancer Campus, Grand Paris, France. 3. Department of Pathology, IUCT, Toulouse, France. 4. Department of Digestive Surgery, Jean Minjoz University Hospital, Besançon, France. 5. Department of Surgical Oncology, Val d'Aurelle Montpellier Cancer Institute, Montpellier, France. 6. Department of Surgical Oncology, Claudius Regaud Institute - IUCT, Toulouse, France. 7. Department of Digestive Surgery, Estaing University Hospital, Clermont-Ferrand, France. 8. Department of Surgical Oncology, Francois Baclesse Comprehensive Cancer Center, Caen, France. 9. Department of Surgery, Léon Bérard Comprehensive Cancer Center, Lyon, France. 10. Surgical Oncologic & Digestive Unit, Lariboisière University Hospital, INSERM, U 965, Paris, France. 11. Department of General Surgery and Gastrointestinal Oncology, Archet 2 University Hospital, Nice, France. 12. Department of Digestive Surgery, University Hospital of Saint Etienne, Saint Etienne, France. 13. Department of Digestive Surgery, Michallon University Hospital, Grenoble, France. 14. Department of General Surgery, Hautepierre University Hospital, Strasbourg, France. 15. Department of Surgical Oncology, Lorraine Institute of Oncology, Vandoeuvre-les-Nancy, France. 16. Department of Surgical Oncology, René Gauducheau Integrated Center of Oncology, Nantes, France. 17. Department of Surgical Oncology, Paul Papin Integrated Center of Oncology, Angers, France. 18. Department of Surgical Oncology, Paoli-Calmettes Institute, Marseille, France. 19. Department of Surgical Oncology, Bergonie Institute, Bordeaux, France. 20. Department of Surgical Oncology, Curie Institute, Paris, France. 21. Department of Digestive Surgical Oncology, University Hospital of Dijon, Dijon, France. 22. Department of Pathology, Lyon-Sud University Hospital, Lyon, France. 23. Clinical Research Unit, Pôle IMER (Information Médicale Evaluation et Recherche), Hospices Civils de Lyon, Lyon, France. 24. Department of Digestive Surgery, Lyon-Sud University Hospital, EMR 3738, Lyon 1 University, Lyon, France. Electronic address: olivier.glehen@chu-lyon.fr.
Abstract
PURPOSE: Diffuse malignant peritoneal mesothelioma (DMPM) is a severe disease with mainly locoregional evolution. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is the reported treatment with the longest survival. The aim of this study was to evaluate the impact of perioperative systemic chemotherapy strategies on survival and postoperative outcomes in patients with DMPM treated with curative intent with CRS-HIPEC, using a multi-institutional database: the French RENAPE network. PATIENTS AND METHODS: From 1991 to 2014, 126 DMPM patients underwent CRS-HIPEC at 20 tertiary centres. The population was divided into four groups according to perioperative treatment: only neoadjuvant chemotherapy (NA), only adjuvant chemotherapy (ADJ), perioperative chemotherapy (PO) and no chemotherapy before or after CRS-HIPEC (NoC). RESULTS: All groups (NA: n = 42; ADJ: n = 16; PO: n = 16; NoC: n = 48) were comparable regarding clinicopathological data and main DMPM prognostic factors. After a median follow-up of 61 months, the 5-year overall survival (OS) was 40%, 67%, 62% and 56% in NA, ADJ, PO and NoC groups, respectively (P = 0.049). Major complications occurred for 41%, 45%, 35% and 41% of patients from NA, ADJ, PO and NoC groups, respectively (P = 0.299). In multivariate analysis, NA was independently associated with worse OS (hazard ratio, 2.30; 95% confidence interval, 1.07-4.94; P = 0.033). CONCLUSION: This retrospective study suggests that adjuvant chemotherapy may delay recurrence and improve survival and that NA may impact negatively the survival for patients with DMPM who underwent CRS-HIPEC with curative intent. Upfront CRS and HIPEC should be considered when achievable, waiting for stronger level of scientific evidence.
PURPOSE: Diffuse malignant peritoneal mesothelioma (DMPM) is a severe disease with mainly locoregional evolution. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is the reported treatment with the longest survival. The aim of this study was to evaluate the impact of perioperative systemic chemotherapy strategies on survival and postoperative outcomes in patients with DMPM treated with curative intent with CRS-HIPEC, using a multi-institutional database: the French RENAPE network. PATIENTS AND METHODS: From 1991 to 2014, 126 DMPMpatients underwent CRS-HIPEC at 20 tertiary centres. The population was divided into four groups according to perioperative treatment: only neoadjuvant chemotherapy (NA), only adjuvant chemotherapy (ADJ), perioperative chemotherapy (PO) and no chemotherapy before or after CRS-HIPEC (NoC). RESULTS: All groups (NA: n = 42; ADJ: n = 16; PO: n = 16; NoC: n = 48) were comparable regarding clinicopathological data and main DMPM prognostic factors. After a median follow-up of 61 months, the 5-year overall survival (OS) was 40%, 67%, 62% and 56% in NA, ADJ, PO and NoC groups, respectively (P = 0.049). Major complications occurred for 41%, 45%, 35% and 41% of patients from NA, ADJ, PO and NoC groups, respectively (P = 0.299). In multivariate analysis, NA was independently associated with worse OS (hazard ratio, 2.30; 95% confidence interval, 1.07-4.94; P = 0.033). CONCLUSION: This retrospective study suggests that adjuvant chemotherapy may delay recurrence and improve survival and that NA may impact negatively the survival for patients with DMPM who underwent CRS-HIPEC with curative intent. Upfront CRS and HIPEC should be considered when achievable, waiting for stronger level of scientific evidence.
Authors: Michele Carbone; Prasad S Adusumilli; H Richard Alexander; Paul Baas; Fabrizio Bardelli; Angela Bononi; Raphael Bueno; Emanuela Felley-Bosco; Francoise Galateau-Salle; David Jablons; Aaron S Mansfield; Michael Minaai; Marc de Perrot; Patricia Pesavento; Valerie Rusch; David T Severson; Emanuela Taioli; Anne Tsao; Gavitt Woodard; Haining Yang; Marjorie G Zauderer; Harvey I Pass Journal: CA Cancer J Clin Date: 2019-07-08 Impact factor: 508.702