Thomas Steffen1, Lukas Häller2, Lana Bijelic3, Markus Glatzer4, Olivier Glehen5, Diane Goéré6, Ignace de Hingh7, Yan Li8, Brendan J Moran9, David L Morris10, Pompiliu Piso11, Claudio A Quadros12, Beate Rau13, Paul Sugarbaker14, Yutaka Yonemura15, Paul M Putora4,16. 1. Department of Surgery, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland, thomas.steffen@kssg.ch. 2. Department of Surgery, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland. 3. Peritoneal Surface Malignancies Unit, Hospital Sant Joan Despi Moises Broggi, Barcelona, Spain. 4. Department of Radiation Oncology, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland. 5. Department of Digestive Surgery, Hospices Civils de Lyon, Lyon, France. 6. Department of Surgery, Gustave Roussy Institute, Villejuif, France. 7. Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands. 8. Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Beijing, China. 9. Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, United Kingdom. 10. Department of Surgery, St. George Hospital and University of New South Wales, Sydney, New South Wales, Australia. 11. Department of Surgical Oncology, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany. 12. Surgical Oncology Unit, São Rafael Hospital, Salvador, Brazil. 13. Department of General Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany. 14. Peritoneal Surface Oncology Unit, MedStar Washington Hospital Center, Washington, District of Columbia, USA. 15. Peritoneal Metastasis Center, Kishiwada Tokushukai Hospital, Osaka, Japan. 16. Department of Radiation Oncology, University of Bern, Bern, Switzerland.
Abstract
OBJECTIVES: To assess the individual treatment strategies among international experts in peritoneal carcinosis, specifically their decision-making in the process of patient selection for hyperthermic intraperitoneal chemotherapy (HIPEC) in women suffering from ovarian cancer, to identify relevant decision-making criteria, and to quantify the level of consensus for or against HIPEC. METHODS: The members of the executive committee of the Peritoneal Surface Oncology Group International (PSOGI) were asked to describe the clinical conditions under which they would recommend HIPEC in patients with ovarian cancer and to describe any disease or patient characteristics relevant to their decision. All answers were then merged and converted into decision trees. The decision trees were then analyzed by applying the objective consensus methodology. RESULTS: Nine experts in surgical oncology provided information on their multidisciplinary treatment strategy including HIPEC for patients with advanced ovarian cancer. Three of the total of 12 experts did not perform HIPEC. Five criteria relevant to the decision on whether HIPEC is performed were applied. In patients with resectable disease, a peritoneal cancer index (PCI) <21, and epithelial ovarian cancer without distant metastasis, consent was received by 75% to perform HIPEC for women suffering from recurrent disease. Furthermore, in the primary disease setting, consent was received by 67% to perform HIPEC according to the same criteria. DISCUSSION AND CONCLUSION: Among surgical oncology experts in peritoneal surface malignancy and HIPEC, HIPEC plays an important role in primary and recurrent ovarian cancer, and the PCI is the most important criterion in this decision.
OBJECTIVES: To assess the individual treatment strategies among international experts in peritoneal carcinosis, specifically their decision-making in the process of patient selection for hyperthermic intraperitoneal chemotherapy (HIPEC) in women suffering from ovarian cancer, to identify relevant decision-making criteria, and to quantify the level of consensus for or against HIPEC. METHODS: The members of the executive committee of the Peritoneal Surface Oncology Group International (PSOGI) were asked to describe the clinical conditions under which they would recommend HIPEC in patients with ovarian cancer and to describe any disease or patient characteristics relevant to their decision. All answers were then merged and converted into decision trees. The decision trees were then analyzed by applying the objective consensus methodology. RESULTS: Nine experts in surgical oncology provided information on their multidisciplinary treatment strategy including HIPEC for patients with advanced ovarian cancer. Three of the total of 12 experts did not perform HIPEC. Five criteria relevant to the decision on whether HIPEC is performed were applied. In patients with resectable disease, a peritoneal cancer index (PCI) <21, and epithelial ovarian cancer without distant metastasis, consent was received by 75% to perform HIPEC for women suffering from recurrent disease. Furthermore, in the primary disease setting, consent was received by 67% to perform HIPEC according to the same criteria. DISCUSSION AND CONCLUSION: Among surgical oncology experts in peritoneal surface malignancy and HIPEC, HIPEC plays an important role in primary and recurrent ovarian cancer, and the PCI is the most important criterion in this decision.