Mesothelioma: Sugarbaker PH

Sugarbaker PH. · No affiliation provided · Gastroenterol Clin Biol. · Pubmed #18166852 No free full text.

This publication has no abstract.

Sugarbaker PH. · No affiliation provided · J Surg Oncol. · Pubmed #17262739 No free full text.

This publication has no abstract.

Sebbag G, Sugarbaker PH. · No affiliation provided · Eur J Surg Oncol. · Pubmed #11373096 No free full text.

This publication has no abstract.

Sugarbaker PH. · Washington Cancer Institute, Washington, DC 20010, USA. · Int J Hyperthermia. · Pubmed #17701534 No free full text.

Abstract: Intraoperative chemotherapy with heat has been identified as a treatment option for patients with cancer spread to peritoneal surfaces. This treatment modality is viewed as a supplement to several other treatments for this group of patients including cytoreductive surgery, systemic chemotherapy, early postoperative intraperitoneal chemotherapy, and long-term bidirectional chemotherapy. The pharmacologic basis for using heat to supplement chemotherapy effects are related to the increased penetration of chemotherapy into tumor with hyperthermia, the delayed clearance of chemotherapy from the peritoneal cavity after direct instillation, and an increased cytotoxicity that has been documented with selected chemotherapy agents. Data to support the use of perioperative hyperthermic intraperitoneal chemotherapy with mucinous appendiceal carcinomatosis comes from a large number of single institution phase II studies. Also, peritoneal and pleural mesothelioma are benefited. In colon cancer carcinomatosis, large phase II multi-institutional trials and a single phase III trial documented an increased median survival of these patients from approximately 1 year to over 2 years. Prophylaxis against peritoneal carcinomatosis in gastric cancer has been demonstrated in phase III trials. In ovarian cancer the rationale for this treatment remains large but its current application is limited. Much work needs to be done to identify a proper clinical perspective on hyperthermia used with chemotherapy in patients with peritoneal surface malignancy.

Yan TD, Welch L, Black D, Sugarbaker PH. · Program in Peritoneal Surface Oncology, Washington Cancer Institute, Washington Hospital Center, Washington, DC, USA. · Ann Oncol. · Pubmed #17130182 links to  free full text

Abstract: BACKGROUND: In the past, diffuse malignant peritoneal mesothelioma (DMPM) was regarded as a preterminal condition. The length of survival was dependent upon the aggressive versus indolent biologic behavior of the neoplasm. The overall median survival was approximately 1 year after systemic chemotherapy. Cytoreductive surgery (CRS) combined with perioperative intraperitoneal chemotherapy (PIC) has been used as a treatment alternative, but the efficacy of this combined treatment remains to be established. PATIENTS AND METHODS: Searches for relevant studies published in peer-reviewed medical journals on CRS and PIC for DMPM before May 2006 were carried out on six databases. The reference lists of all retrieved articles were reviewed for further identification of potentially relevant studies. Expert academic surgeons in Washington, DC, USA were asked whether they knew about any important unpublished data. Two investigators independently evaluated each study according to predefined criteria. The quality of each study was assessed. Clinical effectiveness was synthesized through a narrative review with full tabulation of results of all included studies. RESULTS: Seven prospective observational studies from six tertiary institutions were available, allowing 240 DMPM patients for assessment. The median survival ranged from 34-92 months. The 1-, 3- and 5-year survival varied from 60% to 88%, 43% to 65% and 29% to 59%, respectively. The perioperative morbidity varied from 25% to 40% and mortality ranged from 0% to 8%. CONCLUSIONS: This systematic review evaluated the current evidence for CRS and PIC for DMPM. Seven observational studies were available for assessment, which demonstrated an improved overall survival, as compared to historical controls, using systemic chemotherapy and palliative surgery.

Yan TD, Esquivel J, Carmignani P, Sugarbaker PH. · Washington Hospital Center, Washington, DC, USA. · J Exp Clin Cancer Res. · Pubmed #16767916 No free full text.

Abstract: Peritoneal surface malignancy can arise from pseudomyxoma peritonei, gastrointestinal carcinoma, abdomino-pelvic sarcoma and peritoneal mesothelioma. In the past, only palliative treatments were offered and the results were poor. We have proposed a new concept in managing patients with peritoneal surface malignancy. It involves an aggressive combined treatment modality of cytoreduction and perioperative intraperitoneal chemotherapy. The results are promising for patients with pseudomyxoma peritonei, peritoneal mesothelioma and well-selected patients with invasive peritoneal surface malignancies. The success in such comprehensive treatment depends on tumor biology, patient's co-morbidities, the completeness of cytoreduction, the efficacy of intraperitoneal chemotherapy administration and the surgeon's experience. The importance of patient selection is emphasized. The rationales and the outline of the current management strategies are described. Large phase II studies have demonstrated the marked survival advantage in this aggressive approach to peritoneal surface malignancy.

Sugarbaker PH, Yan TD, Stuart OA, Yoo D. · Program in Peritoneal Surface Oncology, Washington Cancer Institute, Washington Hospital Center, 106 Irving Street, NW, Suite 3900, Washington, DC 20010, USA. · Eur J Surg Oncol. · Pubmed #16621431 No free full text.

Abstract: AIMS: In the past, diffuse malignant peritoneal mesothelioma (DMPM) has been regarded as a terminal condition. The length of the survival was dependent upon the aggressive versus indolent biology of the neoplasm, nevertheless cure was not considered as a reasonable expectation and the overall median survival was approximately one year. METHODS: A comprehensive literature review and a collection of pertinent data published on DMPM from the Washington Cancer Institute were used to construct this report. RESULTS: Recent publications from Bethesda MD, New York, Milan Italy, Lyon France and Washington DC have shown a remarkable prolongation in the median survival of this group of patients with approximately half the patients alive at 5 years. These prolonged survivors were treated with an intensive local-regional treatment strategy that included cytoreductive surgery (CRS) with peritonectomy and hyperthermic intraoperative intraperitoneal chemotherapy (HIIC) and some patients with early postoperative intraperitoneal chemotherapy (EPIC). As larger numbers of patients have been treated, clinical features by which to select patients most likely to benefit from this approach have been identified. Also, as the experience in the management of patients receiving these treatments has increased, the morbidity and mortality associated with their management is being reduced. CONCLUSIONS: A new standard of care involves surgical removal of large disease deposits combined with perioperative intraperitoneal chemotherapy. Knowledgeable management uses selection criteria and incurs low morbidity and mortality.

Sugarbaker PH, Welch LS, Mohamed F, Glehen O. · Program in Peritoneal Surface Malignancy, Washington Cancer Institute, 110 Irving St., NW, Washington, DC 20010, USA. · Surg Oncol Clin N Am. · Pubmed #14567020 No free full text.

Abstract: This article reviews a single institution's experience with 68 patients (21 females, 47 males) prospectively treated over the last 2 decades with an aggressive local-regional approach, combining maximal cytoreductive surgery with heated intraoperative intraperitoneal chemotherapy and early postoperative intraperitoneal chemotherapy. This multimodality treatment has resulted in a median survival of 67 months. Female patients had a significantly better prognosis than males. The other significant predictive factors of survival were: age, diagnosis by incidental findings, tumor extent, pathology, and completeness of cytoreduction.

Sethna K, Mohamed F, Marchettini P, Elias D, Sugarbaker PH. · The Washington Cancer Institute, Washington Hospital Center, Washington, DC 20010, USA. · Tumori. · Pubmed #12729358 No free full text.

Abstract: BACKGROUND: Cystic peritoneal mesothelioma is a rare disease associated with a favorable short-term prognosis. Longer follow-up documenting a persistence of symptoms and a high rate of recurrence after debulking surgery along with an uncertain natural history prompt a re-evaluation of prior treatment recommendations. No prior long-term clinical study of these patients is available. METHODS: The experience with five cases of cystic peritoneal mesothelioma, four females and one male, are reviewed. All of these patients were treated with cytoreductive surgery with peritonectomy procedures and heated intraoperative intraperitoneal chemotherapy. CT, pathology and current status were investigated in order to learn more about the natural history of this disease. RESULTS: All patients were symptomatic from abdominal distention and three of the four complained of severe pain. Female patients complained of long periods of recurrent abdominal and pelvic pain poorly managed by oral analgesics. In one patient prolonged conservative management over ten years resulted in transition to an invasive process with extensive lymph nodal metastases. Her prognosis for long-term survival is guarded because of mesothelioma extension into the chest. Disease control of both ascites and pain in the abdomen and pelvis was achieved in all five patients treated with cytoreductive surgery plus intraperitoneal chemotherapy. CONCLUSIONS: Cystic peritoneal mesothelioma should no longer be referred to as "benign" cystic mesothelioma. An aggressive approach with complete disease eradication is the correct goal of treatment. From our experience, cytoreductive surgery to remove all visible tumor and intraperitoneal chemotherapy to control microscopic residual disease will help patients with peritoneal cystic mesothelioma to remain symptom- and disease-free over an extended time period with a single surgical intervention. Disease eradication may prevent the transition to an aggressive and fatal disease process.

Mohamed F, Sugarbaker PH. · The Washington Cancer Institute, Washington Hospital Center, 110 Irving Street, NW, Suite CG-185, Washington, DC 20010, USA. · Curr Treat Options Oncol. · Pubmed #12194803 No free full text.

Abstract: Peritoneal mesothelioma is usually a rapidly fatal primary peritoneal surface malignancy with a median survival time of less than 1 year, mainly because of lack of effective treatment. The incidence is approximately one per 1,000,000; approximately one fifth to one third of all mesotheliomas are peritoneal. Because of its unusual nature, the disease has not been clearly defined in terms of its natural history, diagnosis, or management. Treatment options with intravenous chemotherapy are far from satisfactory. However, because malignant peritoneal mesothelioma usually remains confined to the peritoneal cavity for most of its natural history, regional chemotherapy is an attractive option. From a theoretic perspective, the treatments are most likely to succeed in selected patients with small-volume residual disease after cytoreductive surgery. Advantages of intraperitoneal chemotherapy include greatly enhanced drug concentrations in the peritoneal cavity and decreased systemic toxicity. In designing an intraperitoneal treatment strategy for the management of peritoneal mesothelioma, the limited number of active cytotoxic drugs and the timing of drug delivery pose problems. Prognosis as determined by clinical presentation, the completeness of cytoreduction, and gender (female patients survive longer than male patients) appears to be improved by the use of intraperitoneal chemotherapy. Over the past decade, the management of these patients has evolved similarly to ovarian cancer treatment and now involves cytoreductive surgery, heated intraoperative intraperitoneal chemotherapy with cisplatin and doxorubicin, and early postoperative intraperitoneal paclitaxel. These perioperative treatments are followed by adjuvant intraperitoneal paclitaxel and second-look cytoreduction. Prolonged disease-free survival and reduced adverse symptoms with the current management strategy are documented by a high complete response rate as assessed by a negative second look. This multimodality treatment approach with debulking surgery and intraperitoneal chemotherapy has resulted in a median survival of 50 to 60 months. Peritoneal mesothelioma is an orphan disease that is treatable, with expectations for "potential" cure in a small number of patients diagnosed and treated early with definitive local/regional treatments. A prolonged high quality of life is possible in the majority of patients.

González-Moreno S, Yan H, Alcorn KW, Sugarbaker PH. · The Washington Cancer Institute, Washington Hospital Center, Washington, District of Columbia 20010, USA. · J Surg Oncol. · Pubmed #11920782 No free full text.

Abstract: BACKGROUND AND OBJECTIVES: Peritoneal mesothelioma is being diagnosed with greater accuracy as a result of immunocytochemical analysis. The histological type of peritoneal mesothelioma has a great influence on the natural history of the disease. Benign cystic mesothelioma is a definite clinical entity; however, the absence of a uniform approach to treatment and a lack of long-term follow-up of patients seriously hinders an accurate assessment of the disease process. METHODS: The medical history of a patient with a diagnosis of benign peritoneal cystic mesothelioma followed for 10 years is presented. The medical literature of this disease is reviewed. RESULTS: The patient was a 36-year-old woman initially diagnosed with benign cystic peritoneal mesothelioma; however, after six surgical procedures with the aim of reducing the volume of intraperitoneal fluid and cysts, the disease developed into an aggressive, diffuse malignant mesothelioma. Involvement of abdominal incisions, invasion of lymph nodes, and invasion of the viscera occurred. CONCLUSIONS: Peritoneal cystic mesothelioma is a disease in need of careful longitudinal studies in order to better define the clinical course of these patients. This case report along with a literature review suggests caution in the assessment of cystic mesothelioma as a benign process. This patient had a clear malignant transformation of benign cystic mesothelioma to an invasive and potentially lethal process.

Sugarbaker PH. · Washington Cancer Institute, Washington Hospital Center, DC 20010, USA. · Jpn J Clin Oncol. · Pubmed #11902487 links to  free full text

Abstract: BACKGROUND: Peritoneal surface malignancy can result from seeding of gastrointestinal cancer or abdomino-pelvic sarcoma; it can also occur as a primary disease, such as peritoneal mesothelioma. In the past, this clinical situation was treated only with palliative intent. METHODS: An aggressive approach to peritoneal surface malignancy involves peritonectomy procedures, perioperative intraperitoneal chemotherapy and knowledgeable patient selection. The clinical assessments necessary for valid clinical judgements include the cancer histopathology (invasive vs expansive progression), the preoperative abdominal and pelvic CT, the peritoneal cancer index and the completeness of cytoreduction score. Proper patient selection is mandatory for optimizing the results of treatment. RESULTS: In a series of phase II studies, appendiceal tumors with peritoneal seeding became the paradigm for success with an 85% long-term survival in selected patients. Carcinomatosis from colon cancer had an overall 5-year survival of 50% with selected patients. Also, sarcomatosis patients overall had a 40% 5-year survival in selected patients. Peritoneal mesothelioma showed a 36% 5-year survival. In all malignancies, early aggressive treatment of minimal peritoneal surface dissemination showed the greatest benefit. CONCLUSIONS: Oncologists must accept responsibility for knowledgeable management of peritoneal surface dissemination of cancer because a curative approach has been demonstrated in large phase II studies and all historical controls show 0% long-term survival. Adjuvant phase III studies with perioperative intraperitoneal chemotherapy in diseases where peritoneal surface spread occurs are indicated.

Sugarbaker PH. · Washington Cancer Institute, Washington Hospital Center, Washington, DC 20010, USA. · Langenbecks Arch Surg. · Pubmed #10654274 No free full text.

Abstract: BACKGROUND: Peritoneal surface malignancy can result from seeding of gastrointestinal cancer or abdominopelvic sarcoma; it can also occur as a primary disease, for example, peritoneal mesothelioma. In the past, this clinical situation was treated only with palliative intent. METHODS: An aggressive approach to peritoneal surface malignancy involves peritonectomy procedures, perioperative intraperitoneal chemotherapy and knowledgeable patient selection. The clinical assessments necessary for valid clinical judgements include the cancer histopathology (invasive vs expansive progression), the preoperative abdominal and pelvic computed tomogram, the peritoneal cancer index and the completeness of cytoreduction score. Proper patient selection is mandatory for optimizing the results of treatment. RESULTS: In a series of phase-II studies, appendiceal tumors with peritoneal seeding was the paradigm for success with a 75% long-term survival in properly selected patients. Carcinomatosis from colon cancer had an overall 5-year survival of 20% but with selected patients this reached 50%. Also, sarcomatosis patients overall had only a 10% 5-year survival but selected patients had a 75% survival. In all malignancies, early aggressive treatment of minimal peritoneal surface dissemination showed the greatest benefit. CONCLUSIONS: The surgeon must accept responsibility for knowledgeable management of peritoneal surface dissemination of cancer. A curative approach has been demonstrated in large phase-II studies. Adjuvant studies with perioperative intraperitoneal chemotherapy in diseases where peritoneal surface spread occurs are indicated.

Van der Speeten K, Stuart OA, Mahteme H, Sugarbaker PH. · Department of Surgical Oncology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium. · Cancer Chemother Pharmacol. · Pubmed #18654746 No free full text.

Abstract: PURPOSE: A pharmacologic analysis of intracavitary doxorubicin in the treatment of patients with intracavitary cancer dissemination was performed to further evaluate the possible benefits of this treatment modality. METHODS: Twenty appendiceal malignancy patients with peritoneal carcinomatosis (PC), three appendiceal malignancy patients with direct extension into the pleural cavity, 20 patients with peritoneal mesothelioma and one patient with pleural mesothelioma were available for pharmacologic monitoring. After intraperitoneal or intrapleural administration of doxorubicin, plasma and peritoneal fluid samples were obtained at 15, 30, 45, 60 and 90 min in all patients. After intrapleural administration, plasma and pleural fluid samples were collected at similar intervals. Tumor and normal tissues were obtained when available. Doxorubicin concentrations were determined by high-performance liquid chromatography (HPLC). RESULTS: Intraperitoneal doxorubicin showed a prolonged retention in the peritoneal cavity. Doxorubicin concentrations in tumor tissue were consistently elevated above intraperitoneal concentrations from 30 through 90 min. For appendiceal malignancy, the concentrations of doxorubicin were significantly higher in minimally aggressive mucinous tumors. Pleural chemotherapy solutions retained doxorubicin to a greater extent than peritoneal fluid. CONCLUSIONS: Doxorubicin shows characteristics favorable for intracavitary administration with sequestration of doxorubicin in cancer nodules.

Cerruto CA, Brun EA, Chang D, Sugarbaker PH. · Department of Pathology, Washington Hospital Center, Washington, DC 20010, USA. · Arch Pathol Lab Med. · Pubmed #17076527 No free full text.

Abstract: CONTEXT: Diffuse malignant peritoneal mesothelioma is currently regarded as a rare and lethal primary tumor arising from the peritoneal membrane. In the past, treatment plans with variable combinations of surgery and systemic chemotherapy were associated with a median survival of approximately 1 year. Standardized treatments using cytoreductive surgery and perioperative intraperitoneal chemotherapy have extended this survival. OBJECTIVE: To critically analyze the prognostic significance of histomorphologic parameters as a determinant of survival. DESIGN: Sixty-two consecutive patients with diffuse malignant peritoneal mesothelioma in whom data were prospectively accumulated were retrospectively analyzed by 14 different histomorphologic parameters. The influences of these pathologic characteristics on survival were critically statistically evaluated. RESULTS: In a univariate analysis, histologic type, nuclear/nucleolar size, stroma, depth of invasion into the bowel, atypical mitoses, mitotic index, necrosis, lymph node involvement, and chromatin patterns were found to be significant. In the multivariate analysis, histologic type and nuclear/nucleolar size remained as determinant histomorphologic characteristics. Use of biphasic/sarcomatoid histologic type as a poor prognostic characteristic was limited in that only 8% of patients showed this histology. CONCLUSIONS: Histomorphologic parameters carry prognostic significance in predicting the survival of patients with diffuse malignant peritoneal mesothelioma when treated in a standardized fashion using cytoreductive surgery and perioperative intraperitoneal chemotherapy. Nuclear/nucleolar size was found to be a reliable histomorphologic assessment available to assess prognosis in these patients.

Yan TD, Popa E, Brun EA, Cerruto CA, Sugarbaker PH. · Washington Cancer Institute, Washington, DC 20010, USA. · Br J Surg. · Pubmed #17048277 No free full text.

Abstract: BACKGROUND: Diffuse malignant peritoneal mesothelioma (DMPM) is rare and in the past has proved an invariably fatal disease. Female patients have been reported to have an improved survival outcome for reasons that are not understood. METHODS: The survival of 34 men and 28 women who underwent cytoreduction and perioperative intraperitoneal chemotherapy for DMPM was compared. Twenty-five clinicopathological variables were subjected to univariate analysis. RESULTS: The women had a 5-year survival rate of 63 per cent and median survival was not reached. The men had a 5-year survival rate of 42 per cent, with a median survival of 32 months (P = 0.045). Women had undergone more extensive previous surgery and had less extensive peritoneal involvement at the time of cytoreduction. Tumours in women more frequently showed a small nuclear size (30 microm or less) and the chromatin pattern was more often granular than clear. CONCLUSION: Women with DMPM had better survival. This observation may be related to the favourable clinical and histopathological features associated with women.

Yan TD, Brun EA, Cerruto CA, Haveric N, Chang D, Sugarbaker PH. · Washington Hospital Center, Washington Cancer Institute, 106 Irving Street, NW, Suite 3900N, Washington, DC 20010, USA. · Ann Surg Oncol. · Pubmed #17039392 No free full text.

Abstract: BACKGROUND: This study evaluates clinical, radiological and histopathological prognostic indicators for survival of patients undergoing cytoreductive surgery and perioperative intraperitoneal chemotherapy for diffuse malignant peritoneal mesothelioma (DMPM). METHODS: Sixty-two consecutive patients with DMPM underwent cytoreduction and perioperative intraperitoneal chemotherapy at the Washington Cancer Institute. Twenty-six clinical, radiological and histopathological parameters were analyzed in univariate and multivariate analyses using overall survival as an endpoint. RESULTS: The overall survival was 79 months (range 1-143 months), with 1-, 3- and 5-year survival rates of 84%, 58% and 50%, respectively. The following 14 prognostic variables were significant for survival in the univariate analysis: gender (P = .045), peritoneal cancer index (P = .038), completeness of cytoreduction score (P = .010), interpretive CT findings of the small bowel and mesentery (P = .001), mesothelioma cell type (P < .001), mesothelioma nuclear size (P < .001), nuclear/cytoplasmic ratio (P < .001), mitotic count (P < .001), atypical mitosis (P < .001), chromatin pattern (P < .001), cellular necrosis (P < .001), perineural invasion (P = .037), stroma pattern (P < .001) and depth of invasion (P = .014). In the multivariate analysis, the only factor that was independently associated with an improved survival after cytoreduction and perioperative intraperitoneal chemotherapy was mesothelioma nuclear size. CONCLUSIONS: Mesothelioma nuclear size was the dominant factor determining overall survival in patients with DMPM. A histopathological staging system based on measurement of the nuclear size was proposed.

Yan TD, Edwards G, Alderman R, Marquardt CE, Sugarbaker PH. · Peritoneal Surface Malignancy Program, Washington Cancer Institute, Washington Hospital Center, 106 Irving Street, NW, Suite 3900N, Washington, DC 20010, USA. · Ann Surg Oncol. · Pubmed #17031722 No free full text.

Abstract: BACKGROUND: Although many reports regarding morbidity and mortality of cytoreductive surgery plus perioperative intraperitoneal chemotherapy are available, there are no prospective data on morbidity and mortality limited to patients with diffuse malignant peritoneal mesothelioma (DMPM). METHODS: This prospective morbidity and mortality assessment was performed on 70 consecutive cytoreductive procedures with perioperative intraperitoneal chemotherapy for DMPM. Forty-seven adverse events by eight categories were rated from grades I to IV with increasing severity. Grade I morbidity was self-limiting; grade II required medical treatments; grade III required an invasive intervention; grade IV required returning to the operating room or intensive care management. Risk factors for grades III and IV morbidity were determined. RESULTS: The perioperative mortality rate was 3%. The grades III and IV morbidity rates were 27 and 14%, respectively. Primary colonic anastomosis (P = 0.028), more than four peritonectomy procedures (P = 0.015), duration of the operation of more than 7 h (P = 0.027) were the risk factors for grade IV morbidity. Survival analysis of these 70 patients was provided. CONCLUSIONS: The morbidity and mortality results for cytoreductive surgery and perioperative intraperitoneal chemotherapy for patients with DMPM were within the acceptable range for major gastrointestinal surgery. Grade IV morbidity was associated with more extensive cytoreduction.

Yan TD, Yoo D, Sugarbaker PH. · Peritoneal Surface Malignancy Program, 106 Irving Street, NW, Suite 3900N, Washington Cancer Institute, Washington Hospital Center, Washington, DC 20010, USA. · Eur J Surg Oncol. · Pubmed #16806796 No free full text.

Abstract: BACKGROUND: Diffuse malignant peritoneal mesothelioma (DMPM) is a rare and invariably fatal neoplasm. Some studies have shown that cytoreductive surgery (CRS) combined with perioperative intraperitoneal chemotherapy (PIC) achieved an improved survival, as compared to historical controls. However, the significance of lymph node involvement in this disease has never been well defined. METHODS: One hundred patients with DMPM underwent CRS and PIC at the Washington Hospital Center. The inclusion criteria for surgery consisted of histological diagnosis of DMPM, age <80 years and good performance status. All data were collected prospectively. Lymph node status, seven clinical variables and eight treatment-related prognostic factors were analyzed for survival. RESULTS: Seven patients were lymph node positive and they all died of their disease within 2 years after the surgery. The remaining 93 patients had 5- and 7-year survival of 50% and 43%, respectively. Univariate analysis showed that gender (p<0.001), peritoneal cancer index (p=0.009), lymph node status (p<0.001), extra-abdominal invasion (p=0.026), histological type (p<0.001), intraoperative blood loss (p=0.035), completeness of cytoreduction (p<0.001), intraperitoneal chemotherapy regimen (p=0.041), and redo cytoreductive surgery (p=0.022) were significant for survival. Multivariate analysis demonstrated that female gender, lymph node metastasis not detected, epithelial type, and adequate cytoreduction were independently associated with an improved survival. CONCLUSIONS: CRS and PIC showed an improved survival for DMPM, as compared to historical controls. Lymph node status along with three other prognostic variables was significant in the multivariate analysis.

Garofalo A, Valle M, Garcia J, Sugarbaker PH. · General-Oncological Surgery, Department of Surgery, S. Camillo Hospital, Rome, Italy. · Eur J Surg Oncol. · Pubmed #16631341 No free full text.

Abstract: AIM: To report the use of laparoscopic Intraperitoneal Hyperthermic Chemotherapy (LIPHC) in the treatment of malignant ascites. METHODS: From September 2001 to December 2003, 14 patients between the age of 56 and 78years were treated. Ascites was from gastric cancer (5 cases), colorectal cancer (3 cases), ovarian cancer (3 cases), breast cancer (2 cases) and peritoneal mesothelioma (1 case). The LIPHC was carried out at 42 degrees C for 90 min with 1.5% dextrose solution as a carrier. Chemotherapy was cisplatin and doxorubicin or mitomycin depending on the type of primary tumor. The drains were left in situ after surgery and removed when perfuse drainage ceased. RESULTS: Ascites was controlled in all the treated cases. A CT scan performed in follow-up showed a small, clinically undetectable, fluid accumulation in the pelvis of one patient. CONCLUSIONS: This method resulted in benefit for those peritoneal carcinomatosis patients with debilitating malignant ascites who were excluded from cytoreductive surgery. Proficiency in laparoscopic staging procedures and experience in the management of carcinomatosis and intraperitoneal hyperthermic chemotherapy (IPHC) are required for the success of the procedure.

Yan TD, Stuart OA, Yoo D, Sugarbaker PH. · Peritoneal Surface Malignancy Program, Washington Cancer Institute, Washington, DC, USA. · J Transl Med. · Pubmed #16606461 links to  free full text

Abstract: The treatment of peritoneal surface malignancy mainly focuses on diffuse malignant peritoneal mesothelioma, pseudomyxoma peritonei from appendiceal cancer, and peritoneal dissemination from gastrointestinal and ovarian cancers. Cancer progression causes peritoneal implants to be distributed throughout the abdominopelvic cavity. These nodules plus the ascitic fluid result in abdominal distension. As the disease progresses, these tumors cause intestinal obstruction leading to debilitating symptoms and a greatly impaired quality of life. In the past, the prognosis of patients with peritoneal surface malignancy was regarded dismal and cure was not an option. Recently, cytoreductive surgery combined with perioperative intraperitoneal chemotherapy has shown an improved survival in selected patients with this disease. To date, multiple different treatment regimens of perioperative intraperitoneal chemotherapy have been used. This review focuses on the perioperative intraperitoneal chemotherapy currently in use in conjunction with cytoreductive surgery for the treatment of peritoneal surface malignancy at the Washington Cancer Institute.

Yan TD, Haveric N, Carmignani CP, Bromley CM, Sugarbaker PH. · Program in Peritoneal Surface Malignancy, Washington Cancer Institute, Washington Hospital Center, DC 20010, USA. · Tumori. · Pubmed #16459635 No free full text.

Abstract: AIMS AND BACKGROUND: Peritoneal mesothelioma is a rare disease with a universally fatal outcome when managed in a traditional palliative manner. New approaches to treatment using cytoreductive surgery and intraperitoneal chemotherapy suggest that long-term survival is possible in selected patients. Early recognition of this disease process with an orderly surgical approach will begin to optimize treatment. METHODS: Thirty-three patients with malignant peritoneal mesothelioma had CT scans available for review. A Z-score was used to evaluate the incidence of cancer at a particular anatomic site as compared to a general incidence of disease at all sites. CT was analyzed by abdominopelvic anatomic sites (16), abdominopelvic regions (9), and for presence versus absence of disease in the chest. Interpretative CT findings (class 0-III) were determined for these 33 patients. RESULTS: Eight of 33 patients had pleural abnormalities. In an analysis of 16 abdominopelvic anatomic sites, the vesical or rectal uterine pouch was involved in 97% and the greater omentum in 91%. These anatomic sites were the only ones with a positive Z-score of >1. In the analysis of 9 abdominopelvic regions, the central and pelvic regions had Z-scores >2 for large volume disease >5 cm. For CT interpretative findings class I, class II and class III was determined in approximately one-third in each category. Sixty-six percent of the patients had ascites by CT. CONCLUSIONS: Malignant peritoneal mesothelioma by CT evaluation predominates in tumor mass within the central and pelvic portions of the abdomen. Minimal, moderate, and extensive small bowel enlargements were seen in roughly one-third of the patients. With the use of the Z-score and interpretative small bowel findings a radiologic characterization of this disease for primary radiologic diagnosis is possible.

Sugarbaker PH. · Washington Cancer Institute, Washington, DC 20010, USA. · J Surg Oncol. · Pubmed #16231365 No free full text.

This publication has no abstract.

Welch LS, Acherman YI, Haile E, Sokas RK, Sugarbaker PH. · Center to Protect Workers' Rights, Silver Spring, Maryland 20910, USA. · Int J Occup Environ Health. · Pubmed #16130966 No free full text.

Abstract: The proportion of peritoneal mesotheliomas among all mesotheliomas has been decreasing, leading some to suggest that peritoneal mesothelioma occurs only after high levels of exposure to asbestos. To investigate the relationship between asbestos exposure and the development of peritoneal mesothelioma, a case-control study examined 40 cases of primary peritoneal mesothelioma from a single institution. This series differed from previous reports in that 75% of the cases and controls had attended college. Results show an odds ratio of 6.6 for asbestos exposure among this group of primary peritoneal mesothelioma cases with relatively slight asbestos exposures.

Sethna K, Sugarbaker PH. · Washington Cancer Institute, Washington, DC, USA. · Hepatogastroenterology. · Pubmed #16001635 No free full text.

Abstract: Peritoneal mesothelioma is a surface malignancy involving the serous surfaces of the abdominal cavity. In the case presented here, the disease presented itself in a manner that has not been previously described. The tumor involved the full thickness of the bowel besides the familiar surface spread which is characteristic of the disease. Intestinal obstruction is a rare or late presentation of mesothelioma. It was the presenting symptom in the present case due to the full thickness infiltration of the small bowel by the tumor. The offending segment was resected and the ascites was treated with intraperitoneal chemotherapy. Though the patient at present has progression of disease he enjoys a reasonable quality of life after palliation of the ascites and obstruction.