\[Treatment of primary and metastatic peritoneal tumors in the Covid-19 pandemic. Proposals for prioritization from the RENAPE and BIG-RENAPE groups\]

Our plain-English summary of [Treatment of primary and metastatic peritoneal tumors in the Covid-19 pandemic. Proposals for prioritization from the RENAPE and BIG-RENAPE groups], by O. Glehen, V. Kepenekian, O. Bouché, et al (Journal de Chirurgie Viscérale, 2020).

The study

• Authors: O. Glehen, V. Kepenekian, O. Bouché, L. Gladieff, C. Honore, RENAPE-BIG-RENAPE
• Journal: Journal de Chirurgie Viscérale
• Published: 2020;157(3):S25-S32
• Type of article: Review
• Language: French
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

The Covid-19 pandemic is profoundly changing the organization of healthcare access. This is particularly so for peritoneal neoplastic diseases, for which curative treatment mobilizes substantial personnel, operating room and intensive care resources. The BIG-RENAPE and RENAPE groups have made tentative proposals for prioritizing care provision. A tightening of the usual selection criteria is needed for curative care: young patients with few or no comorbidities and limited peritoneal extension. It is desirable to prioritize disease conditions for which cytoreduction surgery with or without associated hyperthermic intraoperative peritoneal chemotherapy (HIPEC) is the gold-standard treatment, and for which systemic chemotherapy cannot be a temporary or long-term alternative: pseudomyxoma peritonei, resectable malignant peritoneal mesotheliomas, peritoneal metastases of colorectal origin if they are resectable and unresponsive to systemic chemotherapy after up to 12 courses, first-line ovarian carcinomatosis if resectable or in interval surgery after at most six courses of systemic chemotherapy. Addition of HIPEC must be discussed case by case in an expert center. The prioritization of indications must consider local conditions and the phase of the epidemic to allow optimal peri-operative care.

© 2020 Published by Elsevier Masson SAS.

In plain English

This French-language article was not a study of patients. It was a set of expert proposals from two French peritoneal cancer networks, RENAPE and BIG-RENAPE, on how to prioritize treatment of primary and metastatic tumors of the peritoneum (the lining of the abdomen) during the Covid-19 pandemic. The authors described these as tentative proposals rather than recommendations. The article does not discuss asbestos. The authors proposed tightening the usual selection criteria for curative treatment, favoring young patients with few or no comorbidities and limited peritoneal disease. They proposed prioritizing conditions for which cytoreduction surgery is the standard treatment and systemic chemotherapy is no alternative. Cytoreduction surgery removes visible tumor and may be combined with HIPEC, heated chemotherapy delivered into the abdomen during surgery. Resectable malignant peritoneal mesothelioma was one of these prioritized conditions. For it, they called cytoreduction surgery with HIPEC, without prior systemic chemotherapy, the reference treatment. If surgery could not be scheduled, complete removal was doubtful, or poor prognostic factors were present, cisplatin (or carboplatin) plus pemetrexed chemotherapy could be proposed. The authors stated that no data yet allowed an objective comparison of Covid-19 risks between chemotherapy and major surgery.

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: Expert opinion / position paper ("mise au point") offering proposals, explicitly not recommendations; no new patient data
• Who was studied: No patients were studied; the proposals concern patients in France with primary and metastatic peritoneal tumors during the Covid-19 pandemic (2020)
• Exposure: Not applicable: the article does not discuss asbestos or any fiber exposure; it concerns treatment choices (cytoreduction surgery, HIPEC, systemic chemotherapy) during the pandemic
• Main results:
  • The authors proposed tightening selection criteria for curative care to young patients with few or no comorbidities and limited peritoneal disease
  • Conditions proposed for priority included pseudomyxoma peritonei and resectable malignant peritoneal mesotheliomas
  • For resectable malignant peritoneal mesothelioma, the authors stated that cytoreduction surgery with HIPEC, without neoadjuvant systemic chemotherapy, is the reference treatment
  • For peritoneal mesothelioma, if surgery cannot be scheduled locally, complete resection is in doubt, or poor prognostic factors are present, systemic chemotherapy with cisplatin (or carboplatin) and pemetrexed may be proposed
  • For borderline mesothelioma forms (multicystic, well-differentiated papillary) without symptoms, the authors proposed postponing surgery until the end of the epidemic period
  • The authors stated that no recommendation can be made for prioritizing chemotherapy over surgery or no treatment on the basis of Covid-19 risk
  • The authors proposed that adding HIPEC be decided case by case in an expert center
• The authors' conclusion: The authors concluded that prioritization of treatment indications must take into account local conditions and the phase of the epidemic, so that care around the time of surgery can be optimal
• Limitations the authors state:
  • The authors stated that no data yet allowed an objective assessment of the relative risk of severe Covid-19 with systemic chemotherapy versus major surgery in cancer patients
  • The authors noted that the preliminary data available on Covid-19 in cancer patients come from studies with a low level of evidence

Topics

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

Related studies

• Treatment of primary and metastatic peritoneal tumors in the Covid-19 pandemic. Proposals for prioritization from the RENAPE and BIG-RENAPE groups — O. Glehen, V. Kepenekian, et al. (2020)
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