Comprehensive Treatment Algorithms of the Swiss Peritoneal Cancer Group for Peritoneal Cancer of Gastrointestinal Origin

Our plain-English summary of Comprehensive Treatment Algorithms of the Swiss Peritoneal Cancer Group for Peritoneal Cancer of Gastrointestinal Origin, by M. Adamina, M. Warlaumont, M.D. Berger, et al (Cancers, 2022).

The study

• Authors: M. Adamina, M. Warlaumont, M.D. Berger, S. Däster, R. Delaloye, A. Digklia, B. Gloor, R. Fritsch, D. Koeberle, T. Koessler, K. Lehmann, P. Müller, R. Peterli, F. Ris, T. Steffen, C.S. Weisshaupt, M. Hübner
• Journal: Cancers
• Published: 2022;14(17)
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Peritoneal cancer (PC) is a dire finding, yet in selected patients, long-term survival is possible. Complete cytoreductive surgery (CRS) together with combination immunochemotherapy is essential to achieve cure. Hyperthermic intraperitoneal chemotherapy (HIPEC) and pressurized intraperitoneal aerosol chemotherapy (PIPAC) are increasingly added to the multimodal treatment. The Swiss Peritoneal Cancer Group (SPCG) is an interdisciplinary group of expert clinicians. It has developed comprehensive treatment algorithms for patients with PC from pseudomyxoma peritonei, peritoneal mesothelioma, gastric, and colorectal origin. They include multimodal neoadjuvant treatment, surgical resection, and palliative care. The indication for and results of CRS HIPEC and PIPAC are discussed in light of the current literature. Institutional volume and clinical expertise required to achieve best outcomes are underlined, while inclusion of patients considered for CRS HIPEC and PIPAC in a clinical registry is strongly advised. The present recommendations are in line with current international guidelines and provide the first comprehensive treatment proposal for patients with PC including intraperitoneal chemotherapy. The SPCG comprehensive treatment algorithms provide evidence-based guidance for the multimodal care of patients with PC of gastrointestinal origin that were endorsed by all Swiss clinicians routinely involved in the multimodal care of these challenging patients.

In plain English

This article was not a study of patients but a set of consensus treatment recommendations (algorithms) from the Swiss Peritoneal Cancer Group. They cover cancer on the abdominal lining arising from pseudomyxoma peritonei, peritoneal mesothelioma, gastric cancer and colorectal cancer. Two authors reviewed published studies and guidelines and drafted four algorithms. These were revised through rounds of expert discussion and endorsed by 7 surgical oncology and 7 medical oncology departments in Switzerland. For peritoneal mesothelioma in patients fit for surgery, the group described removal of all visible tumor plus heated chemotherapy inside the abdomen (CRS HIPEC) as a curative approach, with treatment beforehand for high-risk disease. The background section states that peritoneal mesothelioma has been linked to asbestos exposure, less strongly than pleural mesothelioma. That statement draws on other studies and was not examined here. The authors noted that randomized or prospective comparative studies are rare for most clinical situations. They concluded that complete removal of tumor is the cornerstone of curative treatment.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Consensus treatment algorithms (practice guideline), developed from a literature review by two authors followed by a modified Delphi process of expert rounds
• Who was studied: No patients were studied. The algorithms address patients with peritoneal cancer from pseudomyxoma peritonei, peritoneal mesothelioma, gastric and colorectal origin. They were developed by the Swiss Peritoneal Cancer Group and endorsed by 7 surgical oncology and 7 medical oncology departments in Switzerland, with validation at the group's general assembly on 3 September 2021.
• Exposure: Not an exposure study. The article addresses treatments (cytoreductive surgery, HIPEC, PIPAC, systemic chemotherapy). Its background states, citing other work, that peritoneal mesothelioma has been linked to asbestos exposure, with a weaker association than for pleural mesothelioma.
• Main results:
  • For peritoneal mesothelioma (both main forms) in patients fit for surgery, the group described CRS HIPEC as a curative approach, with no exclusion just because of a high peritoneal cancer index.
  • For high-risk peritoneal mesothelioma, neoadjuvant (before-surgery) therapy is offered. The article lists as high risk: peritoneal cancer index above 17, Ki-67 above 9%, sarcomatoid histology, nodal positive status, or incomplete resection.
  • For pseudomyxoma peritonei, the group recommended CRS HIPEC for patients fit for extensive surgery.
  • For gastric cancer with peritoneal cancer, if the patient is resectable and the peritoneal cancer index is not greater than 6, the group advised standard neoadjuvant chemotherapy.
  • For colorectal cancer with peritoneal cancer, upfront diagnostic laparoscopy is recommended to confirm the diagnosis and assess resectability.
• The authors' conclusion: The authors concluded that completeness of cytoreduction is the cornerstone of a curative approach to peritoneal cancer.
• Limitations the authors state:
  • Randomized or prospective comparative studies are rare for most clinical situations.
  • Data on immune checkpoint inhibitors in the palliative setting for mesothelioma, especially the sarcomatoid type, were not yet mature enough to be integrated in the algorithm.
  • Peritoneal cancer of gynecologic origin is not covered.

Topics

Medical terms in this study, explained in our Lexicon: Cytoreductive Surgery, HIPEC, Chemotherapy, Peritoneal Mesothelioma, Surgical Resection, Palliative Care.

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• Re: "Malignant Pleural Mesothelioma Among Swiss Furniture Workers: A New High-Risk Group" by CE Minder, J.P Vader. Scand J work Environ Health 1988;14:252-6 — E. Merler, P. Ricci (1989)
• Multicenter comprehensive methodological and technical analysis of 832 pressurized intraperitoneal aerosol chemotherapy (PIPAC) interventions performed in 349 patients for peritoneal carcinomatosis treatment: An international survey study — M. Nowacki, M. Alyami, et al. (2018)
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