The long-term survival of heavily pretreated patients with primary peritoneal cancer (PPC) is uncommon. Here, we report on a patient with PPC refractory to multiple lines of intravenous chemotherapy, namely, a combined regimen of paclitaxel and carboplatin, and single regimens of topotecan, docetaxel, cisplatin, and gemcitabine. However, after intraperitoneal (IP) chemotherapy with paclitaxel-cisplatin, the patient's condition improved, and she has been progression-free for more than 4 years. Interestingly, before the IP chemotherapy, the recurrences were limited to the peritoneal cavity. These results suggest that IP recurrence might be a predictor of a good response to IP chemotherapy.
Carboplatin ; Cisplatin ; Drug Therapy ; Humans ; Infusions, Parenteral ; Neoplasm Recurrence, Local ; Ovarian Neoplasms ; Paclitaxel ; Peritoneal Cavity ; Peritoneal Neoplasms ; Recurrence ; Topotecan

Intraperitoneal carcinomatosis accounts for 25~35% of recurrences of colorectal cancer, and peritoneal carcinomatosis from colorectal cancer has been regarded as a lethal condition. However, a combination of aggressive cytoreductive surgery and intraperitoneal chemotherapy has been tried and appears to be beneficial in selected patients. The primary goal of cytoreductive surgery is to remove all visible tumor within the peritoneal cavity. The goal of intraperitoneal chemotherapy is to eradicate the microscopic residual tumor and to prevent its recurrence. There are various ways to perform intraperitoneal chemotherapy. One is postoperative intraperitoneal chemotherapy, and another is intraoperative hyperthermic chemotherapy during surgery. Hyperthermia increases the penetration of chemotherapy into tissues and the level of chemotherapy cytotoxicity. The timing of surgery in cases of intraperitoneal chemotherapy and the optimal dosage of drugs must be evaluated in further studies. In colorectal cancer, the peritoneum should be regarded as an intra-abdominal organ, like the liver. Therefore, intraperitoneal carcinomatosis must be treated by using a combination of aggressive surgical treatment and intraperitoneal chemotherapy. Eventually, the long-term overall survival will be increased.
Carcinoma* ; Colorectal Neoplasms* ; Drug Therapy ; Fever ; Humans ; Liver ; Neoplasm, Residual ; Peritoneal Cavity ; Peritoneum ; Recurrence

Three large randomized trials (GOG-104, GOG-114, GOG-172) have shown the advantage of a combination of intravenous (IV) and intraperitoneal (IP) administration of chemotherapy over IV administration alone in optimally-debulked ovarian cancer. A significant advantage of IP chemotherapy is that high concentrations of drugs can be maintained within the peritoneal cavity with less systemic toxicity than IV chemotherapy of similar doses. Two pharmacokinetic problems appear to limit the effectiveness of IP chemotherapy: poor tumor penetration by the drug and incomplete irrigation of serosal surfaces by the drug-containing solution. Combined IP/IV administration of chemotherapy may be associated with a significantly increased short-term risk of toxicity compared with IV chemotherapy. However, the toxicity is usually short-term and manageable. Substitution of carboplatin for cisplatin may reduce the toxicity of IP platinum, but the optimal IP regimen for women with optimally-debulked ovarian cancer should be determined. In conclusion, patients with optimally-debulked FIGO stage III ovarian cancer should be counseled about the clinical benefit associated with combined IV and IP administration of chemotherapy.
Carboplatin ; Cisplatin ; Drug Therapy* ; Female ; Humans ; Infusions, Parenteral ; Ovarian Neoplasms ; Peritoneal Cavity ; Platinum

The standard treatment for epithelial ovarian cancer is maximal cytoreductive surgery and adjuvant chemotherapy. Neoadjuvant chemotherapy can be considered as an alternative treatment strategy when unacceptable primary surgery, in terms of gross residual tumor remaining at the end of cytoreduction, is expected or in cases where poor general condition renders extensive cytoreductive surgery unsuitable. Intraperitoneal chemotherapy is ideal for epithelial ovarian cancer because its spread is mainly limited to the peritoneal cavity. Several randomized controlled trials have reported a survival gain with intraperitoneal chemotherapy. However, disadvantages such as port-related complications, abdominal pain, and neurotoxicity hinder its wide use. Hyperthermic intraperitoneal chemotherapy (HIPEC) after cytoreductive surgery has been suggested as an alternative treatment strategy for intraperitoneal chemotherapy. Ongoing clinical trials of hyperthermic intraperitoneal chemotherapy will quantify clinical outcomes in the future, such as the survival benefit in epithelial ovarian cancer.
Abdominal Pain ; Chemotherapy, Adjuvant ; Drug Therapy* ; Neoplasm, Residual ; Ovarian Neoplasms* ; Peritoneal Cavity

BACKGROUND: Peritoneal carcinomatosis is the most common type of treatment failure in gastric cancer patients. For the purpose of decreasing the rate of peritoneal carcinomatosis, intraperitoneal chemotherapy is a very attractive treatment modality, especially in the aspect of direct infusion of the anti-cancer regimen into the peritoneal cavity. METHODS: The effects of intraperitoneal chemotherapy with cisplatin were evaluated using 360 gastric adenocarcinoma patients with serosal invasion who had received a curative gastric resection from June 1992 to June 1996. Among them, 136 cases were treated by installation of cisplatin 100 mg (mixed with 800 ml of normal saline) into the peritoneal cavity before closing the peritoneum, and the solution was drained out 2 hours later. An analysis was performed to determine the differences of survival rate and mode of recurrence between the intraperitoneal cisplatin installation group and the control group (who did not receive the intraperitoneal chemotherapy). RESULTS: The differences between those two groups were not statistically significant. We assume that such results were due to the patients being more advanced in the cisplatin-treated group than in the control group, although the comparison was between identically staged groups. CONCLUSIONS: Intraperitoneal chemotherapy with cisplatin did not show an improved survival rate and did not change the recurrent mode after surgery for serosal invasive gastric cancer. However, well- designed, prospective, randomized study should be performed. Also a prospective randomized study with other kinds of regimens or a more tolerable dose for each regimen will be needed for a correct evaluation of the effect of intraperitoneal chemotherapy.
Adenocarcinoma ; Carcinoma ; Cisplatin ; Drug Therapy* ; Humans ; Peritoneal Cavity ; Peritoneum ; Recurrence ; Stomach Neoplasms* ; Survival Rate ; Treatment Failure

Peritoneal metastasis of gastrointestinal cancer is an independent factor that seriously affects the prognosis of patients. The "seed-soil" theory is considered to be the main theory to explain peritoneal metastasis. Because of the small size of peritoneal metastatic nodules at the initial stage, early diagnosis is particularly difficult, therefore, the risk assessment of peritoneal metastasis is very important. Recently, the diagnosis methods have gradually developed from clinicopathological factors to cytology and molecular level. In addition, the integrated assessment of multiple groups including radiomics further enriches the accurate diagnosis of peritoneal metastasis. Peritoneal metastasis is a big challenge in the treatment of gastrointestinal cancer which may also lead to refractory malignant ascites, intestinal obstruction, cachexia and other related complications. At present, the treatment is based on systemic chemotherapy. The combination of surgery, intraperitoneal chemotherapy and HIPEC is an effective treatment for peritoneal metastasis of gastrointestinal cancer. How to enrich peritoneal metastasis patients with potential benefits, how to determine the timing of conversion surgery, how to further optimize the existing treatment plan, especially how to formulate treatment plan for patients after conversion surgery, call for improved study design and prospective randomized controlled trials. The goal of continuous efforts is to effectively prolong the survival of gastrointestinal cancer trials patients with peritoneal metastasis.
Antineoplastic Combined Chemotherapy Protocols ; Combined Modality Therapy ; Gastrointestinal Neoplasms/drug therapy* ; Humans ; Hyperthermia, Induced ; Peritoneal Neoplasms/drug therapy* ; Peritoneum ; Prospective Studies ; Stomach Neoplasms/therapy*

OBJECTIVETo evaluated the safety and efficacy of hyperthermic intraperitoneal perfusion chemotherapy(HIPC) in the prevention and treatment of pseudomyxoma peritonei (PMP) recurrence after cytoreductive surgery(CRS).

METHODSStudies published in English before 2010 on HIPC after CRS for PMP were searched in PubMed database. Each study was carefully evaluated based on pre-determined criteria. Study results were comprehensively displayed in a form. A descriptive systematic review was performed.

RESULTSA total of 11 studies were included. The median survival time of patients in these studies ranged from 25.6 months to 156 months. The ranges of 1-year, 2-year, 3-year, 5-year, and 10-year survival rates were 72%-100%, 55%-96%, 59%-96%, 52%-96%, and 55%-96%, respectively. The overall complication rate ranged from 2%-15%, and the total perioperative mortality were from 0 to 7%.

CONCLUSIONHIPC after CRS is effective and safe for patients with PMP.

Chemotherapy, Cancer, Regional Perfusion ; methods ; Humans ; Peritoneal Neoplasms ; drug therapy ; surgery ; Postoperative Care ; Pseudomyxoma Peritonei ; drug therapy ; surgery ; Treatment Outcome

A paraneoplastic syndrome is a disease or symptom that is the consequence of the presence of cancer in the body but is not due to the local presence of cancer cells. Thus, successful treatment of the underlying tumor often improves such syndromes. Amylase-producing lung cancer, multiple myeloma, and ovarian cancer are reported only rarely. In Korea, no cases of hyperamylasemia have been reported in patients with primary peritoneal carcinoma. We report an interesting case of hyperamylasemia suspected to have been induced by primary peritoneal carcinoma. The patient's amylase isoenzyme patterns indicated salivary-type amylase. Hyperamylasemia was reduced in parallel with the response to chemotherapy. These data confirmed the diagnosis of amylase-producing primary peritoneal carcinoma.
Amylases ; Diagnosis ; Drug Therapy ; Humans ; Hyperamylasemia ; Korea ; Lung Neoplasms ; Multiple Myeloma ; Ovarian Neoplasms ; Paraneoplastic Syndromes ; Peritoneal Neoplasms

Pancreatoblastoma is a rare primary pancreatic neoplasm of children that may arise in any portion of the pancreas. We report a case of a 3-yr-old boy who presented to with abdominal pain our hospital and a progressive bulge in his right abdomen. Biochemical evaluation and serum levels of tumoral markers were within reference limits. On the computed tomography, two tumors were found. One located in the head of the pancreas; however, a laparotomy revealed that the head of pancreas was compressed but normal. The other was in the left abdomen near the spleen and the tail of the pancreas. The diagnosis of two synchronous pancreatoblastoma originating from the omentum was confirmed by pathology. Therefore, a pancreatoblastoma should be considered when a large well-defined, lobulated, and heterogeneous mass is identified in the pancreas of children. In addition, an ectopic pancreatoblastoma should be considered when identified within or near the ectopic pancreatic tissue.
Antineoplastic Agents/therapeutic use ; Child, Preschool ; Drug Therapy, Combination ; Humans ; Laparotomy ; Male ; Pancreatic Neoplasms/drug therapy/*pathology/surgery ; Peritoneal Neoplasms/drug therapy/pathology/surgery ; Tomography, X-Ray Computed

Malignant mesothelioma is a highly malignant disease that most often occurs in the pleural cavity, followed by the peritoneum and pericardium. Malignant peritoneal mesothelioma (MPM) accounts for 10%-15% of all mesothelioma. The most important risk factor for MPM is exposure to asbestos. MPM has no specific clinical symptoms, imaging and histopathology are critical for the diagnosis. There are currently no generally accepted guidelines for curative treatment of MPM. The patient mainly presented with abdominal pain, abdominal distension and discomfort. Due to extensive omentum metastasis, no further surgical treatment was performed. Pemetrexed combined with cisplatin chemotherapy was given for 2 cycles, and the patient is still alive.
Humans ; Mesothelioma, Malignant/drug therapy* ; Mesothelioma/diagnosis* ; Pemetrexed/therapeutic use* ; Cisplatin/therapeutic use* ; Peritoneal Neoplasms/diagnosis* ; Pleural Neoplasms ; Lung Neoplasms/drug therapy*