Thomas Steffen1, Paul Martin Putora2, Martin Hübner3, Beat Gloor4, Kuno Lehmann5, Christoph Kettelhack6, Michel Adamina7, Ralph Peterli8, Jan Schmidt9, Frédéric Ris10, Markus Glatzer11. 1. Department of Surgery, Kantonsspital St Gallen, St Gallen, Switzerland. Electronic address: Thomas.Steffen@kssg.ch. 2. Department of Radiation Oncology, Kantonsspital St Gallen, St Gallen, Switzerland; Department of Radiation Oncology, University of Bern, Bern, Switzerland. 3. Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland. 4. Department of Surgery, Inselspital, University Hospital of Bern, Bern, Switzerland. 5. Department of Surgery and Transplantation, University Hospital of Zürich, Zürich, Switzerland. 6. Department of Surgery, University Hospital of Basel, Basel, Switzerland. 7. Department of Surgery, Kantonsspital Winterthur, Winterthur, Switzerland. 8. Department of Surgery, St Claraspital, Basel, Switzerland. 9. Department of Surgery, Klinik Hirslanden, Zürich, Switzerland. 10. Department of Surgery, University Hospital of Geneva, Geneva, Switzerland. 11. Department of Radiation Oncology, Kantonsspital St Gallen, St Gallen, Switzerland.
Abstract
BACKGROUND: The management of patients with colorectal cancer (CRC) with peritoneal metastases is challenging, and the roles of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are unclear and debated among experts. MATERIALS AND METHODS: The experts of the Swiss Peritoneal Cancer Group were contacted and agreed to participate in this analysis. Experts from 9 centers in Switzerland provided their decision algorithms for CRS/HIPEC for patients with or at high risk for peritoneal metastases from CRC. Their responses were converted into decision trees on the basis of objective consensus methodology. The decision trees were used as a basis to identify consensus and discrepancies. RESULTS: The final treatment algorithms included a total of 5 decision criteria (age, Peritoneal Cancer Index [PCI], extraperitoneal metastases, Peritoneal Surface Disease Severity Score, and various risk factors [RF]) and 2 treatment options (HIPEC, yes or no). HIPEC was never recommended for patients without peritoneal metastases in the absence of RF for peritoneal metastases. For patients with a PCI ≤15 without organ metastases, all centers recommended CRS/HIPEC. There was also a consensus not to perform CRS/HIPEC in elderly patients (80 years and older), those with a PCI >20, and those with unresectable metastases. For patients with a PCI = 16 to 20, there was no consensus. CONCLUSION: Multiple decision criteria relevant to all participating centers were identified. Because patient selection for CRS/HIPEC remains difficult, uniform criteria for the term "high risk" for peritoneal metastases and systemic metastases are helpful. Future trials and guidelines should take these criteria into account.
BACKGROUND: The management of patients with colorectal cancer (CRC) with peritoneal metastases is challenging, and the roles of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are unclear and debated among experts. MATERIALS AND METHODS: The experts of the Swiss Peritoneal Cancer Group were contacted and agreed to participate in this analysis. Experts from 9 centers in Switzerland provided their decision algorithms for CRS/HIPEC for patients with or at high risk for peritoneal metastases from CRC. Their responses were converted into decision trees on the basis of objective consensus methodology. The decision trees were used as a basis to identify consensus and discrepancies. RESULTS: The final treatment algorithms included a total of 5 decision criteria (age, Peritoneal Cancer Index [PCI], extraperitoneal metastases, Peritoneal Surface Disease Severity Score, and various risk factors [RF]) and 2 treatment options (HIPEC, yes or no). HIPEC was never recommended for patients without peritoneal metastases in the absence of RF for peritoneal metastases. For patients with a PCI ≤15 without organ metastases, all centers recommended CRS/HIPEC. There was also a consensus not to perform CRS/HIPEC in elderly patients (80 years and older), those with a PCI >20, and those with unresectable metastases. For patients with a PCI = 16 to 20, there was no consensus. CONCLUSION: Multiple decision criteria relevant to all participating centers were identified. Because patient selection for CRS/HIPEC remains difficult, uniform criteria for the term "high risk" for peritoneal metastases and systemic metastases are helpful. Future trials and guidelines should take these criteria into account.
Authors: O Maas; F Forrer; M Maas; C M Panje; J Blautzik; M Brühlmeier; I Engel-Bicik; L Giovanella; A Haldemann; M E Kamel; S Kneifel; C Rottenburger; N Schaefer; M A Walter; S Weidner; P M Putora Journal: Eur J Nucl Med Mol Imaging Date: 2019-11-09 Impact factor: 9.236
Authors: Michel Adamina; Maxime Warlaumont; Martin D Berger; Silvio Däster; Raphaël Delaloye; Antonia Digklia; Beat Gloor; Ralph Fritsch; Dieter Koeberle; Thibaud Koessler; Kuno Lehmann; Phaedra Müller; Ralph Peterli; Frédéric Ris; Thomas Steffen; Christian Stefan Weisshaupt; Martin Hübner Journal: Cancers (Basel) Date: 2022-09-01 Impact factor: 6.575