Brice Malgras1,2, Etienne Gayat3, Olivier Aoun4, Réa Lo Dico5, Clarisse Eveno5, Karine Pautrat5, Jean-Baptiste Delhorme6, Guillaume Passot7, Frédéric Marchal8, Olivia Sgarbura9, Gwenael Ferron10, Diane Goéré11, Thierry Andre12, Marc Pocard5. 1. Department of Digestive and Oncologic Surgery, Hôpital Lariboisière - AP-HP, Université Paris Diderot-Paris 7 and INSERM U 965, Paris, France. bricemalgras@hotmail.com. 2. Department of Digestive Surgery, Begin Military Teaching Hospital, Saint Mandé, France. bricemalgras@hotmail.com. 3. Department of Anesthesiology and Critical Care Medicine, Hôpital Lariboisière - AP-HP, Université Paris Diderot-Paris 7 and INSERM U 942, Paris, France. 4. 5th Armed Forces Medical Center, Strasbourg, France. 5. Department of Digestive and Oncologic Surgery, Hôpital Lariboisière - AP-HP, Université Paris Diderot-Paris 7 and INSERM U 965, Paris, France. 6. Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France. 7. Department of General and Oncological Surgery, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France. 8. Department of Surgical Oncology, Institut de cancérologie de Lorraine, CRAN, UMR 7039, Université de Lorraine, CNRS, Vandoeuvre-lès-Nancy, France. 9. Department of Surgical Oncology, Montpellier Cancer Center, Montpellier, France. 10. Department of Surgical Oncology, Claudius Regaud Insitute, Toulouse, France. 11. Department of Surgical Oncology, Gustave Roussy Cancer Campus, Villejuif Cedex, France. 12. Department of Medical Oncology, Hôpital Saint Antoine, Paris, France.
Abstract
BACKGROUND: The introduction of cytoreductive surgery (CRS) in combination with hyperthermic intraperitoneal chemotherapy (HIPEC) improved the prognosis of selected patients with peritoneal mesothelioma (PM). OBJECTIVE: The objective of our study was to evaluate whether different HIPEC agents were associated with different outcomes in patients with PM. METHODS: From the RENAPE database, we selected all patients with histology-proven PM who underwent CRS + HIPEC from 1989 to 2014. Inclusion criteria were age ≤ 80 years, performance status ≤ 2, and no extraperitoneal metastases. RESULTS: Overall, 249 patients underwent CRS + HIPEC for PM. The HIPEC regimen included five chemotherapeutic agents (CAs), consisting of cisplatin, doxorubicin, mitomycin-C, oxaliplatin, and irinotecan. When considering all CAs (alone or in combination), there was no significant statistical difference in regard to postoperative overall survival (OS). However, OS was better when using two CAs (group 2 drugs) versus one CA (group 1 drug) (p = 0.03). The different CA regimens were equally distributed between the two groups. This association between OS and HIPEC agent, as well as a trend for better progression-free survival, were both observed in the two-drug group versus the one-drug group (p = 0.009) for patients undergoing complete cytoreductive surgery (CC-0) with an epithelioid subtype. CONCLUSIONS: This large study seems to show improved OS when combined CAs, especially with platinum-based regimens, are used for HIPEC in patients with PM, but needs to be confirmed by a randomized controlled trial.
BACKGROUND: The introduction of cytoreductive surgery (CRS) in combination with hyperthermic intraperitoneal chemotherapy (HIPEC) improved the prognosis of selected patients with peritoneal mesothelioma (PM). OBJECTIVE: The objective of our study was to evaluate whether different HIPEC agents were associated with different outcomes in patients with PM. METHODS: From the RENAPE database, we selected all patients with histology-proven PM who underwent CRS + HIPEC from 1989 to 2014. Inclusion criteria were age ≤ 80 years, performance status ≤ 2, and no extraperitoneal metastases. RESULTS: Overall, 249 patients underwent CRS + HIPEC for PM. The HIPEC regimen included five chemotherapeutic agents (CAs), consisting of cisplatin, doxorubicin, mitomycin-C, oxaliplatin, and irinotecan. When considering all CAs (alone or in combination), there was no significant statistical difference in regard to postoperative overall survival (OS). However, OS was better when using two CAs (group 2 drugs) versus one CA (group 1 drug) (p = 0.03). The different CA regimens were equally distributed between the two groups. This association between OS and HIPEC agent, as well as a trend for better progression-free survival, were both observed in the two-drug group versus the one-drug group (p = 0.009) for patients undergoing complete cytoreductive surgery (CC-0) with an epithelioid subtype. CONCLUSIONS: This large study seems to show improved OS when combined CAs, especially with platinum-based regimens, are used for HIPEC in patients with PM, but needs to be confirmed by a randomized controlled trial.