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Paul H. Sugarbaker - One of the best experts on this subject based on the ideXlab platform.
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How safe and effective is surgery with Intraperitoneal Chemotherapy for pseudomyxoma peritonei
Nature clinical practice. Gastroenterology & hepatology, 2007Co-Authors: Paul H. SugarbakerAbstract:How safe and effective is surgery with Intraperitoneal Chemotherapy for pseudomyxoma peritonei?
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The approval process for hyperthermic intraoperative Intraperitoneal Chemotherapy.
European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology, 2006Co-Authors: Paul H. Sugarbaker, L. ClarkeAbstract:Abstract Aims To clarify the requirements for Food and Drug Administration approval in the United States for hyperthermic intraoperative Intraperitoneal Chemotherapy administration. Also, to review the status of the approval process in Europe. Methods The obstacles to be overcome for approval by the Food and Drug Administration for a new drug approval and for a new device approval were reviewed. Drugs approved in the past were examined for their potential for current application in this technology. Results The likelihood that the approval of a heater circulator along with the approval for specific Chemotherapy agents for heated intraoperative Intraperitoneal Chemotherapy was judged to be remote. Rather, the continued use of “homemade heater circulators” and the off-label use of appropriate Chemotherapy agents augmented by heat will continue to be the standard of care. The European community currently has several heater circulators approved for hyperthermic intraoperative Intraperitoneal Chemotherapy administration. These devices have been specifically approved for oncologic indications. Conclusions Continued research and development of heated intraoperative Intraperitoneal Chemotherapy is necessary. As the requirement for prevention and treatment of the peritoneal surface component of gastrointestinal and gynecologic oncology expands, new investigations into the approval process in the United States will be necessary. Publication of results from institutions pioneering these new treatment strategies will, of necessity, continue.
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Perioperative Intraperitoneal Chemotherapy for peritoneal surface malignancy
Journal of translational medicine, 2006Co-Authors: Tristan D. Yan, O. A. Stuart, Dal Yoo, Paul H. SugarbakerAbstract:The treatment of peritoneal surface malignancy mainly focuses on diffuse malignant peritoneal mesothelioma, pseudomyxoma peritonei from appendiceal cancer, and peritoneal dissemination from gastrointestinal and ovarian cancers. Cancer progression causes peritoneal implants to be distributed throughout the abdominopelvic cavity. These nodules plus the ascitic fluid result in abdominal distension. As the disease progresses, these tumors cause intestinal obstruction leading to debilitating symptoms and a greatly impaired quality of life. In the past, the prognosis of patients with peritoneal surface malignancy was regarded dismal and cure was not an option. Recently, cytoreductive surgery combined with perioperative Intraperitoneal Chemotherapy has shown an improved survival in selected patients with this disease. To date, multiple different treatment regimens of perioperative Intraperitoneal Chemotherapy have been used. This review focuses on the perioperative Intraperitoneal Chemotherapy currently in use in conjunction with cytoreductive surgery for the treatment of peritoneal surface malignancy at the Washington Cancer Institute.
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Adjuvant Intraperitoneal Chemotherapy for advanced primary gastric cancer.
Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society, 2006Co-Authors: Paul H. SugarbakerAbstract:BACKGROUND For gastric cancer dissemination to the peritoneal cavity is a large part of the natural history. Also, cancer dissemination caused from the trauma of cancer resection can release viable cancer cells into the free peritoneal cavity; these cells implant and then progress as peritoneal carcinomatosis. METHODS From the medical literature a compilation of the results of adjuvant treatment of gastric cancer were reviewed and critically analyzed. A surgical rationale for integrating Intraperitoneal Chemotherapy into the management of advanced primary gastric cancer was sought. RESULTS A theoretical basis for the application of cytotoxic effects of cancer Chemotherapy within the peritoneal cavity as a part of the primary management of gastric cancer was explored. Numerous manuscripts suggested that there was an increased morbidity and mortality with perioperative Intraperitoneal Chemotherapy but the added number of complications was manageable. These data suggest that Intraperitoneal Chemotherapy is of benefit in an adjuvant setting in gastric cancer patients who have a complete resection but who are at high likelihood of local-regional recurrence. SUMMARY Adjuvant Intraperitoneal Chemotherapy for advanced primary gastric cancer has a strong rationale. Numerous reports have established benefit. Wider application of this treatment modality is necessary through education, through additional clinical trials, and through continued publications from peritoneal surface malignancy treatment centers around the world.
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Update on Chemotherapeutic Agents Utilized for Perioperative Intraperitoneal Chemotherapy
The oncologist, 2005Co-Authors: Paul H. Sugarbaker, Jorge Torres Mora, Pablo Carmignani, O. Anthony Stuart, Dal YooAbstract:A new strategy currently under evaluation in patients with peritoneal carcinomatosis from gastrointestinal and gynecologic cancers is perioperative Intraperitoneal Chemotherapy. Although results to date show benefit to carefully selected groups of patients, continued local-regional failure is seen in many treated patients. Continued clinical and laboratory research efforts to improve local-regional effects are desired. The chemotherapeutic agents that have been used in the past or are currently being tested were reviewed. Their pharmacologic properties and clinical features were collected from the medical literature and are reviewed in the text. An organized presentation of available data concerning the drugs available for perioperative Intraperitoneal Chemotherapy for peritoneal surface malignancy was made. From this review, new possibilities for improved doses, schedules, and drug combinations for perioperative Intraperitoneal Chemotherapy may become important in future clinical studies. Continued optimal utilization of Intraperitoneal Chemotherapy treatments in the operating room with hyperthermia or normothermic treatment in the early postoperative period is desirable. Innovative treatment strategies can improve the outcome of patients with peritoneal surface malignancy. The Oncologist 2005;10:112-122
W J Hoskins - One of the best experts on this subject based on the ideXlab platform.
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Distribution of Intraperitoneal Chemotherapy into the pleural cavity.
Obstetrics & Gynecology, 1994Co-Authors: L Vaccarello, V Berghella, S C Rubin, W J HoskinsAbstract:BACKGROUND: Intraperitoneal Chemotherapy is an established treatment for abdominal and pelvic malignancies. Several catheter-related complications have been reported. We report a case of abnormal distribution of Intraperitoneal Chemotherapy into the pleural cavity. CASE: A patient receiving Intraperitoneal cisplatin developed shortness of breath. A pleural effusion was diagnosed and was evacuated by thoracentesis. Abnormal distribution of instilled fluid was responsible for her distress. CONCLUSION: Communications exist between the peritoneal and pleural cavities. The use of Intraperitoneal Chemotherapy or radioactive material may lead to respiratory complications if abnormal distribution occurs.
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Distribution of Intraperitoneal Chemotherapy into the pleural cavity.
Obstetrics and gynecology, 1994Co-Authors: L Vaccarello, V Berghella, S C Rubin, W J HoskinsAbstract:Intraperitoneal Chemotherapy is an established treatment for abdominal and pelvic malignancies. Several catheter-related complications have been reported. We report a case of abnormal distribution of Intraperitoneal Chemotherapy into the pleural cavity. A patient receiving Intraperitoneal cisplatin developed shortness of breath. A pleural effusion was diagnosed and was evacuated by thoracentesis. Abnormal distribution of instilled fluid was responsible for her distress. Communications exist between the peritoneal and pleural cavities. The use of Intraperitoneal Chemotherapy or radioactive material may lead to respiratory complications if abnormal distribution occurs.
David L Morris - One of the best experts on this subject based on the ideXlab platform.
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Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Pseudomyxoma Peritonei and Appendix Tumours
Indian Journal of Surgical Oncology, 2016Co-Authors: Joshua Lansom, Nayef Alzahrani, Winston Liauw, David L MorrisAbstract:Pseudomyxoma peritonei (PMP) is the intra-peritoneal accumulation of mucus due to mucinous neoplasia, most often from a ruptured mucinous appendiceal neoplasm. A similar syndrome is caused by appendix cancer and other gastrointestinal malignancies. Cytoreductive surgery (CRS) and hyperthermic Intraperitoneal Chemotherapy (HIPEC) provides long-term survival in selected patients with these conditions. The management of the appendiceal neoplasm prior to development of peritoneal involvement is initially discussed. This is followed by an overview of the management of peritoneal disease caused by appendiceal neoplasms. The principles and basic techniques of CRS and Intraperitoneal Chemotherapy (both intraoperative and post operative) are then discussed. Survival outcomes from several large studies are summarised. Prognostic factors are also discussed. We report our basic outcome data for the 345 patients with PMP or appendix cancer treated at our institution. Finally, the promising upcoming treatment of mucolytic therapy is discussed. We conclude that appendiceal neoplasms, although rare can cause significant morbidity and mortality. With optimal management long-term survival is possible in the majority of patients. The key to treatment is complete cytoreduction and use of hyperthermic Intraperitoneal Chemotherapy.
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comparative analysis of perioperative Intraperitoneal Chemotherapy regimen in appendiceal and colorectal peritoneal carcinomatosis
International Journal of Clinical Oncology, 2013Co-Authors: Terence C Chua, Winston Liauw, Jing Zhao, David L MorrisAbstract:Background Perioperative Intraperitoneal Chemotherapy (PIC) is delivered by intraoperative hyperthermic Intraperitoneal Chemotherapy (HIPEC) and early postoperative Intraperitoneal Chemotherapy (EPIC). The relative survival benefits of each or both regimens are explored in this large series of patients undergoing cytoreduction at a single institution.
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Palliative effects of an incomplete cytoreduction combined with perioperative Intraperitoneal Chemotherapy.
American journal of clinical oncology, 2010Co-Authors: Terence C Chua, Tristan D. Yan, Jing Zhao, Bilal Baker, David L MorrisAbstract:Objectives: Incomplete cytoreduction often occurs because of overwhelming burden of disease Intraperitoneally that limit a successful cytoreduction. The outcome of an incomplete cytoreduction followed by administering perioperative Intraperitoneal Chemotherapy on whether it prolongs survival or palliates symptoms is yet to be established. Methods: A retrospective review of a prospectively collected database was performed. Eleven patients were identified to have had an incomplete (CC2/3) cytoreduction and received either hyperthermic Intraperitoneal Chemotherapy or early postoperative Intraperitoneal Chemotherapy. The symptoms of the patients before and after treatment during follow-up consultations in clinic were noted. Survival analysis was performed using the Kaplan Meier method. Results: The median follow-up period was 19 (range, 0.5–35) months. The overall median survival was 21 months with a 1- and 2-year survival rate of 72% and 36%, respectively. Five of 7 patients with pseudomyxoma peritonei and 2 of 3 patients with colorectal cancer peritoneal carcinomatosis experienced symptom improvement after treatment. Severe postoperative morbidity and achieving symptomatic improvement following treatment seems to be associated with a dismal prognosis. Conclusion: Our results suggest that some patients derive a survival and symptomatic benefits despite an incomplete cytoreductive surgery and perioperative Intraperitoneal Chemotherapy. The effects of this treatment require further investigation to determine its benefits as a palliative procedure.
L Vaccarello - One of the best experts on this subject based on the ideXlab platform.
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Distribution of Intraperitoneal Chemotherapy into the pleural cavity.
Obstetrics & Gynecology, 1994Co-Authors: L Vaccarello, V Berghella, S C Rubin, W J HoskinsAbstract:BACKGROUND: Intraperitoneal Chemotherapy is an established treatment for abdominal and pelvic malignancies. Several catheter-related complications have been reported. We report a case of abnormal distribution of Intraperitoneal Chemotherapy into the pleural cavity. CASE: A patient receiving Intraperitoneal cisplatin developed shortness of breath. A pleural effusion was diagnosed and was evacuated by thoracentesis. Abnormal distribution of instilled fluid was responsible for her distress. CONCLUSION: Communications exist between the peritoneal and pleural cavities. The use of Intraperitoneal Chemotherapy or radioactive material may lead to respiratory complications if abnormal distribution occurs.
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Distribution of Intraperitoneal Chemotherapy into the pleural cavity.
Obstetrics and gynecology, 1994Co-Authors: L Vaccarello, V Berghella, S C Rubin, W J HoskinsAbstract:Intraperitoneal Chemotherapy is an established treatment for abdominal and pelvic malignancies. Several catheter-related complications have been reported. We report a case of abnormal distribution of Intraperitoneal Chemotherapy into the pleural cavity. A patient receiving Intraperitoneal cisplatin developed shortness of breath. A pleural effusion was diagnosed and was evacuated by thoracentesis. Abnormal distribution of instilled fluid was responsible for her distress. Communications exist between the peritoneal and pleural cavities. The use of Intraperitoneal Chemotherapy or radioactive material may lead to respiratory complications if abnormal distribution occurs.
Greg Mcgregor - One of the best experts on this subject based on the ideXlab platform.
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Morbidity and mortality associated with Intraperitoneal Chemotherapy for Pseudomyxoma peritonei.
American journal of surgery, 2002Co-Authors: Sonia A. Butterworth, O. Neely M. Panton, David J. Klaassen, Greg McgregorAbstract:Background: Many centers include Intraperitoneal Chemotherapy for treatment of pseudomyxoma peritonei. This study documented the morbidity of Intraperitoneal Chemotherapy in a single institution. Methods: A retrospective review of pseudomyxoma peritonei over a 6-year period was undertaken. Treatment, morbidity, and outcome were documented. Results: Eleven patients were identified with an average of 1.9 debulking procedures and 0.8 Chemotherapy courses (0.3 complete). Intraperitoneal Chemotherapy was not completed in 5 patients because of complications (56%): severe abdominal pain, seizure, neutropenia, and thrombocytopenia (the latter resulted in 1 patient’s death). There was no association between incomplete Chemotherapy and recurrence. Recurrence was 64% in those without Chemotherapy and 44% in those with. Follow-up averaged 26 months and actual 3-year survival was 60%. Conclusions: Intraperitoneal chemotherapeutic morbidity and mortality were 56% and 11%, respectively. Chemotherapy was associated with decreased recurrence. To optimize outcomes, multicenter prospective trials will likely be required to further refine Intraperitoneal Chemotherapy protocols. © 2002 Excerpta Medica, Inc. All rights reserved.