Proffered Papers— Surgical Treatment of Sarcomas

PERITONEAL SARCOMATOSIS TREATED BY CYTOREDUCTIVE SURGERY AND INTRAPERITONEAL HYPERTHERMIC PERFUSION

Deraco M, Gronchi A, Pennacchioli E, Baratti D, Bertulli R, Casali PG, Rasponi A, Dileo P, Pilotti S, Vaglini M, Azzarelli A (Istituto Nazionale Tumori, Milan, Italy)

Intervention: Peritoneal Sarcomatosis (PS) is a very aggressive condition with a poor prognosis. We propose to investigate the effect of an aggressive surgery followed by intra peritoneal drugs delivery and local hyperthermia.

Patients and methods: In a phase II clinical study, 21 patients (8 men and 13 women) with PS were treated by cytoreductive surgery (CRS) and intra peritoneal hyperthermic perfusion (IPHP). The median age was 52.3 years (range: 29-74 years). The mean follow-up was 15.6 months (range: 2-44 months). Twelve patients (57%) presented retro peritoneal sarcomas and 9 (43%) patients had visceral ones. Nine, 3 and 9 patients presented grade 1, 2 and 3 respectively. Nine out of 21 (43%) and 4 out of 21 (19%) patients were pre-treated with systemic chemotherapy and radiotherapy, respectively. According to the Japanese classification of intraperitoneal disease extension for gastric cancer, 2 (10%), 11 (52%) and 8 (38%) cases presented P1, P2, and P3 dissemination, respectively. Eighty percent of the patients were rendered optimally cytoreduced (cc-0/cc-1). The IPHP was carried out with the closed abdomen technique, using a preheated polysaline perfusate containing CDDP+MMC or CDDP+DX through a heart-lung pump at a mean flow of 700 ml/min for 60 minutes from the hyperthermic phase (42.5°C).

Results: The overall treatment toxicity and surgical morbidity rates were 14% and 15%, respectively. The treatment related mortality was 0%. Median survival and median progression free survival were 26 months and 6.7 months, respectively. Median time to local progression was 16.3 months.

Conclusions: The results of our study are promising and a randomised controlled clinical trial should be addressed for confirmation.