The 10 Take Home Messages of PSOGI 2016
1. Cytoreductive surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is the standard of care for pseudomyxoma peritonei and diffuse malignant peritoneal mesothelioma. Adequate patient selection remains key.
2. CRS and HIPEC is an integral part of the multidisciplinary treatment of peritoneal metastases of colorectal origin in adequately selected patients.
3. The prophylactic or adjuvant use of HIPEC after radical surgical resection in colorectal adenocarcinoma at high risk of peritoneal recurrence is currently under evaluation in several prospective randomized trials. Although preliminary data is promising, it cannot not be considered a standard of care at the present time.
4. Both Mitomycin C and Oxaliplatin are valid drugs for HIPEC in peritoneal carcinomatosis from gastrointestinal origin (colorectal, appendiceal or gastric cancer). There are no definitive toxicity or oncologic efficacy data to support the superiority of one over the other. The possibility of a sequential use in cases of peritoneal relapse represents an advantage.
5. The use of adjuvant HIPEC within the multidisciplinary treatment of locally-advanced primary gastric cancer is currently under evaluation in prospective controlled randomized trials.
6. The use of CRS and HIPEC as an integral part of the multidisciplinary treatment of peritoneal metastases from gastric cancer is very restrictive and should be limited to clinical trials.
7. There is an urgent need for standardization of peritoneal burden scoring systems in advanced epithelial ovarian cancer. A call for a consensus conference on this topic is pertinent by the appropriate stakeholders.
8. The role of complete CRS and HIPEC is in advanced ovarian epithelial cancer is currently under evaluation in several ongoing prospective randomized trials, both in the upfront and recurrent settings. The first reported phase III trial shows a positive result; confirmation of this finding by currently ongoing trials is awaited.
9. Fine tuning of perioperative intraperitoneal chemotherapy delivery (drugs, dosages, use of molecular agents, new delivery methods) is mandatory in order to further improve current outcomes in the maintenace of the surgical complete response achieved by complete cytoreductive surgery. Basic and translational research in the biology of peritoneal dissemination is strongly encouraged for the same purpose.
10. Numerous prospective studies (registries, phase II and phase III controlled trials) are in the design, execution or analysis phases in all Peritoneal Surface Malignancies around the world. International, multicentric collaboration and commitment are encouraged in order to finalize these and have clinically meaningful data in the near furure.