Vincent C J van de Vlasakker1, Robin J Lurvink1, Peter H Cashin2, Wim Ceelen3, Marcello Deraco4, Diane Goéré5, Santiago González-Moreno6, Kuno Lehmann7, Yan Li8, Brendan Moran9, David L Morris10, Pompiliu Piso11, Claudio A Quadros12, Beate Rau13, S P Somashekhar14, Antonio Sommariva15, Kurt van der Speeten16, John Spiliotis17, Paul H Sugarbaker18, Melissa C C Teo19, Vic J Verwaal20, Yutaka Yonemura21, Olivier Glehen22, Ignace H J T de Hingh23. 1. Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands. 2. Department of Surgical Sciences, Section of Surgery, Uppsala University, Uppsala, Sweden. 3. Department of Gastrointestinal Surgery, Ghent University Hospital Belgium, Gent, Belgium. 4. Department of Surgery, Peritoneal Surface Malignancy Unit, Fondazione IRCCS Instituto Nazionale Dei Tumori di Milano, Milan, Italy. 5. Department of Surgery, Gustave Roussy, Villejuif, France. 6. Department of Surgical Oncology, MD Anderson Cancer Center, Madrid, Spain. 7. Department of Visceral and Transplantation Surgery, University Hospital of Zurich, Zurich, Switzerland. 8. Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital of the Capital Medical University, Beijing, PR China. 9. Peritoneal Malignancy Institute Basingstoke, Hampshire Hospitals Foundation Trust, Basingstoke, United Kingdom. 10. Department of Surgery, St. George Hospital, Sydney, Australia. 11. Department of General and Visceral Surgery, Hospital Barmherzige Brüder, Regensburg, Germany. 12. Department of Surgical Oncology, São Rafael Hospital, Salvador, Brazil. 13. Department of Surgery, Campus Virchow-Klinikum and Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Germany. 14. Department of Surgical Oncology and Robotic Surgery, Manipal Comprehensive Cancer Center, Bengaluru, India. 15. Advanced Surgical Oncology Unit, Surgical Oncology of the Esophagus and Digestive Tract, Veneto Institute of Oncology IOV-IRCCS Padova, Italy. 16. Department of Surgical Oncology, Ziekenhuis Oost-Limburg, Genk, Belgium. 17. Department of Surgical Oncology, European Interbalkan Medical Center, Thessaloniki, Greece. 18. Center for Gastrointestinal Malignancies, MedStar Washington Hospital Center, Washington DC, United States. 19. Department of Surgery, National Cancer Centre, Singapore, Singapore. 20. Department of Surgery, Hospital of South West Jutland, Esbjerg, Denmark. 21. Department of Surgery, Peritoneal Surface Malignancy Center, Kishiwada Tokushukai Hospital, Kishiwada City, Japan. 22. Department of Surgical Oncology, Hospices Civils de Lyon and Lyon Faculty of Medicin, Lyon Sud Hospital, Lyon, France. 23. Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands; GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands. Electronic address: ignace.d.hingh@catharinaziekenhuis.nl.
Abstract
INTRODUCTION: The PRODIGE 7-trial investigated the additional value of Hyperthermic Intraperitoneal Chemotherapy (HIPEC) to cytoreductive surgery (CRS) for patients with colorectal peritoneal metastases (CPM). The results of PRODIGE 7 were presented at the 2018 ASCO meeting showing that 30 min oxaliplatin-based HIPEC did not improve overall survival. The current study investigated the impact of PRODIGE 7 on the worldwide practice of CRS and HIPEC. MATERIALS AND METHODS: CRS-HIPEC experts from 19 countries were invited through the Peritoneal Surface Oncology Group International (PSOGI) to complete an online survey concerning the current CRS-HIPEC practice in their hospital and country, and were asked to appraise the effect of PRODIGE 7. RESULTS: The survey was completed by 18/19 experts. Although their personal opinions of CRS-HIPEC were barely influenced by PRODIGE 7, they reported a substantial impact on daily practice. This included a switch towards Mitomycin-C based HIPEC-regimens and prolongation of HIPEC perfusion time, a reduction in the number of referrals from non-HIPEC centers, a reduction in national consensus, the removal of HIPEC from national guidelines, and a reduced reimbursement rate. CONCLUSION: The PRODIGE 7 has had a major impact on the practice of CRS-HIPEC for CPM worldwide. HIPEC remains an attractive option with potential for control and eradication of disease and further studies into the optimal HIPEC-regimen are urgently needed. Meanwhile, given the complexity of the treatment of patients with CPM, and the proven benefits of optimal CRS, referral of patients with potentially resectable CPM to expert centers is recommended whilst the precise role of HIPEC is further evaluated.
INTRODUCTION: The PRODIGE 7-trial investigated the additional value of Hyperthermic Intraperitoneal Chemotherapy (HIPEC) to cytoreductive surgery (CRS) for patients with colorectal peritoneal metastases (CPM). The results of PRODIGE 7 were presented at the 2018 ASCO meeting showing that 30 min oxaliplatin-based HIPEC did not improve overall survival. The current study investigated the impact of PRODIGE 7 on the worldwide practice of CRS and HIPEC. MATERIALS AND METHODS: CRS-HIPEC experts from 19 countries were invited through the Peritoneal Surface Oncology Group International (PSOGI) to complete an online survey concerning the current CRS-HIPEC practice in their hospital and country, and were asked to appraise the effect of PRODIGE 7. RESULTS: The survey was completed by 18/19 experts. Although their personal opinions of CRS-HIPEC were barely influenced by PRODIGE 7, they reported a substantial impact on daily practice. This included a switch towards Mitomycin-C based HIPEC-regimens and prolongation of HIPEC perfusion time, a reduction in the number of referrals from non-HIPEC centers, a reduction in national consensus, the removal of HIPEC from national guidelines, and a reduced reimbursement rate. CONCLUSION: The PRODIGE 7 has had a major impact on the practice of CRS-HIPEC for CPM worldwide. HIPEC remains an attractive option with potential for control and eradication of disease and further studies into the optimal HIPEC-regimen are urgently needed. Meanwhile, given the complexity of the treatment of patients with CPM, and the proven benefits of optimal CRS, referral of patients with potentially resectable CPM to expert centers is recommended whilst the precise role of HIPEC is further evaluated.