Prognosis of primary peritoneal carcinoma: effect of cytoreductive surgery combined with neoadjuvant chemotherapy after laparoscopic diagnosis and evaluation: a multi-center trial

Objective: To evaluate the clinical outcome and prognosis of patients with primary peritoneal carcinoma (PPC) treated with cytoreductive surgery and neoadjuvant chemotherapy after laparoscopic diagnosis. Material and Methods: We retrospectively reviewed 29 patients with PPC, treated between March 2001 and June 2009 at three hospitals. All patients underwent laparoscopy to diagnose and evaluate whether they were good candidates for optimal cytoreductive surgery. After confirmed to be PPC histologically, the patients who were not suitable to undergo optimal cytoreductive surgery received chemotherapy for three to six cycles before operation, and then underwent cytoreductive surgery, followed with chemotherapy again for six cycles. The study included patient demographics, surgery procedures, surgery stage, pathologic findings, chemotherapy programs, and outcomes. Results: The mean age of the 29 patients was 58.5 years. One patient was at Stage IIIB. 23 at Stage IIIC, and five at Stage IV. The rate of optimal cytoreductive surgery was 79.3%. At the time of this review, three patients had stable disease - two with progressive disease, eight were partial responders, and 16 were complete responders; 16 patients were alive without evidence of disease, seven were alive with disease, and six had died from disease. The mean and median overall survival time was 46 and 48 months. Conclusion: Combination of neoadjuvant chemotherapy and cytoreductive surgery after laparoscopic diagnosis and evaluation is effective in the treatment of patients with PPC.

Laparoscopic diagnosis; Neoadjuvant chemotherapy; Cytoreductive surgery; Primary peritoneal carcinoma; Multi-center trial

[1] August C.Z., Murad T.M., Newton M.: “Multiple focal extraovarian serous carcinoma”. Int. J. Gynecol. Pathol., 1985, 4, 11.

[2] Swerdlow M.: “Mesothelioma of the pelvic peritoneum resembling papillary cystadenocarcinoma of the ovary, case report”. Am. J. Obstet. Gynecol., 1959, 77, 197.

[3] Fromm G.L., Gershenson D.M., Silva E.G.: “Papillary serous carcinoma of the peritoneum”. Obstet. Gynecol., 1990, 75, 89.

[4] Truong L.D., Maccato M.L., Awalt H., Cagle P.T., Schwartz M.R., Kaplan A.L.: “Serous surface carcinoma of the peritoneum: a clinicopathologic study of 22 cases”. Hum. Pathol., 1990, 21, 99.

[5] Resta L., Maiorano E., Zito F.A., Faggiano F., Loizzi P., Ferreri R. et al.: “Multifocal extraovarian serous carcinoma: a histochemical and immunohistochemical study”. Eur. J. Gynaecol. Oncol., 1988, 9, 474.

[6] Raju U., Fine G., Greenawald K.A., Ohorodnik J.M. et al.: “Primary papillary serous neoplasia of the peritoneum: a clinicopathologic and ultrastructural study of eight cases”. Hum. Pathol., 1989, 20, 426.

[7] Demir M.K., Aker F.V., Koksal N.: “Primary serous papillary carcinoma of the peritoneum”. Radiology 2006, 240, 905.

[8] Fowler J.M., Nieberg R.K., Schooler T.A., Berek J.S.: “Peritoneal adenocarcinoma (serous) of Mullerian type: a subgroup of women presenting with peritoneal carcinomatosis”. Int. J. Gynecol. Cancer, 1994, 4, 43.

[9] Stafford-Johnson D.B., Bree R.L., Francis I.R., Korobkin M.: “CT appearance of primary papillary serous carcinoma of the peritoneum”. AJR Am. J. Roentgenol., 1998, 171, 687.

[10] Onda T., Kobayashi H., Nakanishi T., Hatae M., Iwasaka T., Konishi I. et al.: “Phase III trial of upfront debulking surgery versus neoadjuvant chemotherapy for Stage III/IV ovarian, tubal and peritoneal cancers: Japan Clinical Oncology Group Study JCOG0602”. Jpn J. Clin. Oncol., 2004, 34, 43.

[11] Gooneratne S., Sassone M., Blaustein A., Talerman A.: “Serous surface papillary carcinoma of the ovary, a clinicopathologic study of 16 cases”. Int. J. Gynecol. Pathol., 1982, 1, 258.

[12] Rothacker D., Mobius G.: “Varieties of serous surface papillary carcinoma of the peritoneum in Northern Germany: a thirty-year autopsy study”. Int. J. Gynecol. Pathol., 1995, 14, 310.

[13] Dalrymple J.C., Bannatyne P., Russell P., Solomon H.J., Tattersall M.H., Atkinson K. et al.: “Extraovarian peritoneal serous papillary carcinoma. A clinicopathologic study of 31 cases”. Cancer, 1989, 64, 110.

[14] Ransom D.T., Patel S.R., Keeney G.L., Malkasian G.D., Edmonson J.H.: “Papillary serous carcinoma of the peritoneum. A review of 33 cases treated with platin-based chemotherapy”. Cancer, 1990, 66, 1091.

[15] Nam J.H., Kim Y.M., Jung M.H., Kim K.R., Yoo H.J., Kim D.Y. et al.: “Primary peritoneal carcinoma: experience with cytoreductive surgery and combination chemotherapy”. Int. J. Gynecol. Cancer, 2006, 16, 23.

[16] Halperin R., Zehavi S., Langer R., Hadas E., Bukovsky I., Schneider D.: “Primary peritoneal serous papillary carcinoma: a new epidemiologic trend? A matched-case comparison with ovarian serous papillary cancer”. Int. J. Gynecol. Cancer, 2001, 11, 403.

[17] Eltabbakh G.H., Charboneau A.M., Eltabbakh N.G.: “Laparoscopic surgery for large benign ovarian cysts”. Gynecol. Oncol., 2008, 15, 72.

[18] Deffieux X., Castaigne D., Pomel C.: “The role of laparoscopy to evaluate candidates for complete cytoreduction of peritoneal carcinomatosis and hyperthermic intraperitoneal chemotherapy”. Int. J. Gynecol. Cancer, 2006, 1, 35.

[19] Ray-Coquard I., Saba C., Bachelot T., Méeus P., Mignotte H., Blondet R. et al.: “Neoadjuvant chemotherapy and ovarian cancer”. Bull Cancer, 2006, 93, 669.

[20] Piver M.S., Eltabbakh G.H., Hempling R.E., Recio F.O., Blumenson L.E.: “Two sequential studies for primary peritoneal carcinoma: induction with weekly cisplatin followed by either cisplatin- doxorubicincyclophosphamide or paclitaxel-cisplatin”. Gynecol. Oncol., 1997, 67, 141.

[21] McGuire W.P., Hoskins W.J., Brady M.F., Kucera P.R., Partridge E.E., Look K.Y. et al.: “Cyclophosphamide and cisplatin compared with paclitaxel in patients with Stage III and Stage IV ovarian cancer”. N. Engl. J. Med., 1996, 334.

[22] Bloss J.D., Liao S.Y., Buller R.E., Manetta A., Berman M.L., McMeekin S. et al.: “Extraovarian peritoneal serous papillary carcinoma: a case control retrospective comparison to papillary adenocarcinoma of the ovary”. Gynecol. Oncol.; 1993, 50, 347.