Malignant peritoneal disease in its various forms is a devastating condition for patients who suffer from it and it poses a significant challenge for the clinicians taking care of them. Research efforts in this field have traditionally been scarce under the assumption of a uniformly fatal and hopeless outcome.
In the last few decades a renewed interest in peritoneal carcinomatosis and primary peritoneal malignancies has occurred. Unprecedented favourable results reported with the employment of aggressive cytoreductive surgery combined with perioperative intraperitoneal chemotherapy have catalysed a change in the conception and treatment alternatives for these diseases. Selected patients can now be offered a curative-intent combination therapy, whereas in the past only the best possible palliation could be considered.
This book is a comprehensive compilation of the new knowledge in peritoneal surface oncology in the dawn of the twenty-first century. It covers the complete spectrum of the latest research carried out in peritoneal malignant dissemination, from its pathogenesis and molecular mechanisms to the latest clinical trials. Additionally, the essentials of perioperative intraperitoneal chemotherapy and the modern histopathological assessment of peritoneal surface malignancy are reviewed. A unique historical perspective on how this new knowledge has unfolded over the years helps point out the future research directions to be pursued. Leading experts in this field from around the world, including the pioneers who gave birth to this new era in oncology, form an unbeatable and outstanding panel of authors.
Author(s): S. González-Moreno
Series: Recent Results in Cancer Research
Edition: 1
Publisher: Springer
Year: 2007
Language: English
Pages: 183
Advances in Peritoneal Surface Oncology (Recent Results in Cancer Research, Vol. 169)......Page 1
Front-matter......Page 2
Title Page......Page 3
Copyright Page......Page 4
Preface......Page 5
Table of Contents (with page links)......Page 9
List of Contributors......Page 11
1.2 Peritoneal Space to Plasma Barrier......Page 14
1.4 Long-Term Intraperitoneal Chemotherapy......Page 15
1.6 Heated Intraoperative Intraperitoneal Chemotherapy......Page 16
1.7 More Knowledgeable Use of Quantitative Prognostic Indicators for Combined Treatment......Page 17
1.10 Respect for the Peritoneum as a First Line of Defense of Carcinomatosis......Page 18
References......Page 20
2.1 Molecular Mechanisms Involved in Peritoneal Dissemination......Page 23
2.2 Detection of Free Cancer Cells in the Peritoneal Cavity......Page 30
2.3 Clinical Implications and Signifificance of a Positive Cytology......Page 31
References......Page 33
3.2 Anatomy and Microanatomy......Page 36
3.3 Defifinition and Pathological Evaluation of Serosal Involvement......Page 37
3.4 Cytological Assessment of Serosal Involvement......Page 39
3.5.1 Oesophagus......Page 40
3.5.2 Stomach......Page 41
3.5.4 Appendix......Page 42
3.5.5 Colon......Page 44
3.5.6 Rectum......Page 45
3.6 Summary and Conclusions......Page 46
References......Page 47
4.2 The Pharmacokinetic Advantage......Page 50
4.3 Drug Tissue Distribution and Tumour Penetration Depth......Page 52
4.5.1 Direct Cytotoxic Effect of Hyperthermia......Page 53
4.5.2 Thermal Enhancement of Chemotherapeutic Drugs......Page 55
4.6 Drug Choice......Page 56
4.7 Carrier Solutions......Page 57
4.8 Duration of Hyperthermic Chemoperfusion......Page 59
References......Page 60
5 Experimental and Pharmacokinetic Studies in Intraperitoneal Chemotherapy: From Laboratory Bench to Bedside......Page 63
5.1.1 Melphalan......Page 64
5.1.3 Mitomycin C......Page 65
5.2.1 Cisplatin......Page 66
5.2.2 Carboplatin......Page 67
5.2.3 Oxaliplatin......Page 68
5.3.1 Adriamycin......Page 69
5.4.1 Methotrexate......Page 70
5.4.2 5-Fluorouracil and Floxuridine......Page 71
5.4.3 Gemcitabine......Page 72
5.5.2 Topotecan......Page 73
5.6.1 Paclitaxel......Page 74
5.6.2 Docetaxel......Page 75
5.7 Conclusions and Future Directions......Page 76
References......Page 77
6.2 Technique of Intraperitoneal Hyperthermic Chemoperfusion......Page 84
6.3 Closed Technique......Page 85
6.4 Open Abdomen (Coliseum) Technique......Page 86
6.5 Peritoneal Cavity Expander Technique......Page 88
6.6 Developing a HIPEC Program......Page 89
6.7 Summary......Page 90
References......Page 91
7.2 Gastric Cancer......Page 92
7.3 Colorectal Cancer......Page 95
7.4 Ovarian Cancer......Page 96
References......Page 97
8.1 Preoperative Variables......Page 99
8.2.1 Concerning the Peroperative Description of PC......Page 100
8.2.2 Concerning the Completeness of Cytoreduction......Page 102
8.4 Postoperative Variables......Page 103
References......Page 105
9.2 Randomised Study in PC of Colorectal Origin......Page 107
9.3 Lessons from This Study......Page 109
References......Page 111
10.1 Introduction......Page 112
10.3 Neoplastic Mucin-Producing Goblet Cells of the Appendix......Page 113
10.6 Genetics......Page 115
10.8 Apoptosis......Page 117
10.9 Metastasis......Page 118
10.11 Future Investigations......Page 119
References......Page 120
11.2 The Primordial Prognostic Impact of Complete Cytoreduction......Page 122
11.3 Results of Phase II Studies with CCS......Page 123
11.4 Randomized Trial......Page 125
11.6 Current Indications for CCS with HIPEC......Page 126
11.8 Outlook for HIPEC in Colorectal PC......Page 127
References......Page 128
12.2.2 Acinar (Glandular) Pattern......Page 130
12.2.5 Deciduoid Pattern......Page 131
12.2.7 Rhabdoid Pattern......Page 132
12.5 Immunohistochemistry......Page 133
12.5.1.2 Calretinin......Page 134
12.5.1.3 Keratin 5/6......Page 135
12.5.1.6 Thrombomodulin......Page 136
12.5.2.3 Monoclonal Antibody BG-8......Page 137
12.5.2.6 Leu-M1 (CD15)......Page 138
12.6 Electron Microscopy......Page 139
12.7 Conclusions......Page 140
References......Page 141
13.2 Etiology......Page 144
13.2.2 Oncogenesis Not Related to Asbestos......Page 145
13.2.3 Molecular Biology......Page 146
13.4 Natural History......Page 147
13.4.2 Pattern of Spread......Page 148
13.5.1 Radiological Imaging......Page 149
13.6 Staging......Page 150
13.7.3 Combined Treatment......Page 152
13.8.1.2 Intraperitoneal Chemotherapy......Page 153
13.8.1.3 Antitumor Effffect of Hyperthermia......Page 154
13.8.3.1 Cytoreductive Surgery......Page 155
13.8.3.2 Hyperthermic Intraperitoneal Chemotherapy......Page 156
13.9.1 Morbidity and Mortality......Page 157
13.9.3 Biological Markers......Page 158
References......Page 159
14.1 Results of Previous Clinical Studies in Carcinomatosis of Gastric Origin......Page 163
14.2 Rationale and Results of Neoadjuvant Intraperitoneal-Systemic Chemotherapy......Page 164
14.2.1 Methods and Results of NIPS......Page 165
14.2.2 Peritonectomy After NIPS and Results......Page 166
14.3 Conclusions and Directions for Future Clinical Research......Page 168
References......Page 169
15.2 Theoretical Rationale for Intraperitoneal Chemotherapy......Page 171
15.3 Preclinical Evaluation of Intraperitoneal Chemotherapy......Page 172
15.4.3 Adequacy of Drug Distribution......Page 173
15.6 Phase II Trials of Intraperitoneal Chemotherapy in Ovarian Cancer......Page 174
15.6.1 Cisplatin-Based Second-Line Intraperitoneal Chemotherapy of Ovarian Cancer......Page 175
15.7.2 Phase III Trial of Intraperitoneal versus Intravenous Cisplatin, with All Patients Also Receiving Intravenous Paclitaxel......Page 176
15.7.3 Phase III Trial of Intravenous Cisplatin/Paclitaxel Versus Intraperitoneal Cisplatin plus Both Intravenous and Intraperitoneal Paclitaxel......Page 177
15.9 What Is the “Optimal” Primary Intraperitoneal Chemotherapy Regimen in Small-Volume Residual Advanced Ovarian Cancer?......Page 178
15.11 Conclusion......Page 179
References......Page 180
