Published August 1, 2018 | Version v1
Publication Open

II.e) Peritoneal metastases from ovarian carcinoma

Creators

  • 1. Duke-NUS Medical School
  • 2. Danylo Halytsky Lviv National Medical University
  • 3. Aarhus University Hospital
  • 4. National Cancer Centre Singapore
  • 5. Instituto Nacional de Cancerología
  • 6. Odense University Hospital
  • 7. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
  • 8. Hôpital Lyon Sud
  • 9. Instituto Jalisciense de Cancerología
  • 10. Universidad Nacional Autónoma de México
  • 11. Calvert Memorial Hospital

Description

ObjectivesCRS and HIPEC is one of the treatment strategies that is being employed for ovarian patients with peritoneal metastases (PM).However, despite careful patient selection and complete macroscopic resection, early recurrences (ER) still occur.This study aims to identify risk factors for ER in these patients. MethodsPatients with ovarian PM treated with CRS and HIPEC between January 2001 and June 2016 at the National Cancer Centre Singapore were analysed.Comparison between patients who developed ER (<12 months) and those with late recurrence (>12 months) or no recurrence was performed using univariate and multivariate analyses.to the NCI-CTCAE criteria) acute kidney injury (AKI) occurred at a rate of 10.6% in our patient population.We propose a series of renal protective measures to eliminate high grade AKI in patients who receive HIPEC with cisplatin. MethodsIn this prospective study, we instituted a protocol of renal protective measures and evaluated its effectiveness in preventing post-operative AKI.The 4 main pillars included:1. Adopting renal-adjusted dosing guidelines using pre-operative creatinine clearance for the dosing of intraoperative intraperitoneal cisplatin.2.Aggressive intra-and post-operative hydration with balanced crystalloids, aiming for a minimum of 2 ml/kg/hour of urine output.3.Decreasing of HIPEC temperature to 39 degrees celsius.4.Simultaneous intravenous infusion of sodium thiosulfate (STS), starting during initiation of HIPEC with a loading dose of 7.5 gm/m2 for 20 minutes, followed by a 12 hour maintenance dose of 15.3 gm/m2. ResultsThis protocol was administered to 23 consecutive patients undergoing HIPEC with cisplatin.All had normal renal function pre-operatively.Post-HIPEC, none of our patients developed high-grade AKI. 4 patients (17%) developed grade 1 AKI and the rest (19) retained normal renal function during their hospitalization.The creatinine levels of all patients returned to baseline at time of discharge, and remained normal on subsequent outpatient visits. ConclusionThis initial small phase 1 cohort study shows that a multi-pronged approach using tailored cisplatin doses, lowered temperature, aggressive peri-operative hydration, and renal neutralization of cisplatin with sodium thiosulfate, is a useful protocol that can potentially significantly reduce the incidence of post-HIPEC AKI. E03

⚠️ This is an automatic machine translation with an accuracy of 90-95%

Translated Description (Arabic)

الأهداف CRS و HIPEC هي واحدة من استراتيجيات العلاج التي يتم استخدامها لمرضى المبيض الذين يعانون من الانبثاث البريتوني (PM). ومع ذلك، على الرغم من الاختيار الدقيق للمريض والاستئصال العياني الكامل، لا تزال التكرارات المبكرة (ER) تحدث. تهدف هذه الدراسة إلى تحديد عوامل الخطر لـ ER في هؤلاء المرضى. طرق تم تحليل المرضى الذين يعانون من PM المبيضيين الذين عولجوا بـ CRS و HIPEC بين يناير 2001 ويونيو 2016 في المركز الوطني للسرطان في سنغافورة. تم إجراء مقارنة بين المرضى الذين طوروا ER (<12 شهرًا) وأولئك الذين لديهم تكرار متأخر (>12 شهرًا) أو عدم تكرار باستخدام تحليلات أحادية ومتعددة المتغيرات. وفقًا لمعايير NCI - CTCAE، حدثت إصابة الكلى الحادة (AKI) بمعدل 10.6 ٪ في عدد المرضى لدينا. اقترحنا سلسلة من تدابير الوقاية الكلوية للقضاء على AKI عالي الدرجة في المرضى الذين يتلقون HIPEC مع السيسبلاتين. الأساليب في هذه الدراسة الاستباقية، وضعنا بروتوكولًا لتدابير الحماية الكلوية وقمنا بتقييم فعاليتها في الوقاية من AKI بعد العملية الجراحية. تضمنت الركائز الأربع الرئيسية ما يلي:1. اعتماد إرشادات الجرعات المعدلة كلويًا باستخدام تصفية الكرياتينين قبل الجراحة لجرعات السيسبلاتين داخل الصفاق أثناء العملية الجراحية. 2. ترطيب عدواني داخل وبعد العملية الجراحية مع بلورات متوازنة، تهدف إلى ما لا يقل عن 2 مل/كجم/ساعة من إخراج البول. 3. انخفاض درجة حرارة HIPEC إلى 39 درجة مئوية. 4. التسريب الوريدي المتزامن لثيوسلفات الصوديوم (STS)، بدءًا من بدء HIPEC بجرعة تحميل 7.5 جم/م 2 لمدة 20 دقيقة، تليها جرعة صيانة لمدة 12 ساعة تبلغ 15.3 جم/م 2. النتائج تم إعطاء هذا البروتوكول لـ 23 مريضًا متتاليًا يخضعون لـ HIPEC مع السيسبلاتين. جميعهم لديهم وظائف كلوية طبيعية قبل الجراحة. بعد HIPEC، لم يصاب أي من مرضانا بـ AKI عالي الدرجة. 4 مرضى (17 ٪) طوروا AKI من الدرجة الأولى والباقي (19) حافظوا على وظائف الكلى الطبيعية أثناء دخولهم المستشفى. عادت مستويات الكرياتينين لجميع المرضى إلى خط الأساس في وقت الخروج، وظلت طبيعية في زيارات العيادات الخارجية اللاحقة. الخاتمة تُظهر هذه الدراسة الأترابية الأولية للمرحلة الأولى الصغيرة أن اتباع نهج متعدد الجوانب باستخدام جرعات سيسبلاتين مخصصة، ودرجة حرارة منخفضة، وترطيب عدواني حول العملية الجراحية، وتحييد كلوي للسيسبلاتين مع ثيوسلفات الصوديوم، هو بروتوكول مفيد يمكن أن يقلل بشكل كبير من حدوث AKI بعد HIPEC. E03

Translated Description (English)

ObjectivesCRS and HIPEC is one of the treatment strategies that is being employed for ovarian patients with peritoneal metastases (PM).However, despite careful patient selection and complete macroscopic resection, early recurrences (ER) still occur .This study aims to identify risk factors for ER in these patients. Methods Patients with ovarian PM treated with CRS and HIPEC between January 2001 and June 2016 at the National Cancer Centre Singapore were analysed. Comparison between patients who developed ER (<12 months) and those with late recurrence (>12 months) or no recurrence was performed using univariate and multivariate analyses. To the NCI-CTCAE criteria) acute kidney injury (AKI) occurred at a rate of 10.6% in our patient population. We proposed a series of renal protective measures to eliminate high grade AKI in patients who receive HIPEC with cisplatin. MethodsIn this prospective study, we instituted a protocol of renal protective measures and evaluated its effectiveness in preventing post-operative AKI.The 4 main pillars included:1. Adopting renal-adjusted dosing guidelines using pre-operative creatinine clearance for the dosing of intraoperative intraperitoneal cisplatin.2. Aggressive intra-and post-operative hydration with balanced crystalloids, aiming for a minimum of 2 ml/kg/hour of urine output.3. Decreasing of HIPEC temperature to 39 degrees celsius.4. Simultaneous intravenous infusion of sodium thiosulfate (sts), starting during initiation of HIPEC with a loading dose of 7.5 gm/m2 for 20 minutes, followed by a 12-hour maintenance dose of 15.3 gm/m2. ResultsThis protocol was administered to 23 consecutive patients undergoing HIPEC with cisplatin.All had normal renal function pre-operatively.Post-HIPEC, none of our patients developed high-grade AKI. 4 patients (17%) developed grade 1 AKI and the rest (19) retained normal renal function during their hospitalization.The creatinine levels of all patients returned to baseline at time of discharge, and remained normal on subsequent outpatient visits. Conclusion This initial small phase 1 cohort study shows that a multi-pronged approach using tailored cisplatin doses, lowered temperature, aggressive peri-operative hydration, and renal neutralization of cisplatin with sodium thiosulfate, is a useful protocol that can potentially significantly reduce the incidence of post-HIPEC AKI. E03

Translated Description (French)

ObjectivesCRS and HIPEC is one of the treatment strategies that is being employed for ovarian patients with peritoneal metatases (PM).However, despitite careful patient selection and complete macroscopic resection, early recurrences (ER) still occur.This study aims to identify risk factors for ER in these patients. MethodsPatients with ovarian PM treated with CRS and HIPEC between January 2001 and June 2016 at the National Cancer Centre Singapore were analysed.Comparison between patients who developed ER (<12 months) and those with late recurrence (>12 months) or no recurrence was performed using univariate and multivariate analyses.to the NCI-CTCAE Gibralia) aiguë kidney injury (AKI) occurrente at a rate of 10.6% in our patient population.We proposed a series of renal protective measures to eliminate high grade AKI in patients who receive HIPEC with cisplatin. MethodsIn this prospective study, we instituted a protocol of rein protective measures and evaluated its effectiveness in preventing post-operative AKI.The 4 main pillars included :1. Adopting rein-adjusted dosing guidelines using pre-operative creatinine clearance for the dosing of intraoperative intrapéritoneal cisplatin.2.Aggressive intra-and post-operative hydration with balanced crystalloids, aiming for a minimum of 2 ml/kg/hour of urine output.3.Decreasing of HIPEC temperature to 39 degrees celsius.4.Simultaneous intravenous infusion of sodium thiosulfate (STS), starting during initiation of HIPEC with a loading dose of 7.5 gm/m2 for 20 minutes, followed by a 12 hour maintenance dose of 15.3 gm/m2. ResultsThis protocol was administrtered to 23 consecutive patients undergoing HIPEC with cisplatin.All had normal rein function pre-operatively.Post-HIPEC, none of our patients developed high-grade AKI. 4 patients (17 %) developed grade 1 AKI and the rest (19) retained normal reinction during their hospitalalization.The creatinine levels of all patients returned to baseline at time of discharge, and remained normal on subsequent outpatient visits. ConclusionThis initial small phase 1 cohort study shows that a multi-pronged approach using tailored cisplatin doses, lowered temperature, aggressive peri-operative hydration, and rein neutralization of cisplatin with sodium thiosulfate, is a useful protocol that can potentially significantly reduce the incidence of post-HIPEC AKI. E03

Translated Description (Spanish)

ObjectivesCRS and HIPEC is one of the treatment strategies that is being employed for ovarian patients with peritoneal metastases (PM).However, despite careful patient selection and complete macroscopic resection, early recurrences (ER) still occur.This study aims to identify risk factors for ER in these patients. MethodsPatients with ovarian PM treated with CRS and HIPEC between January 2001 and June 2016 at the National Cancer Centre Singapore were analysed.Comparison between patients who developed ER (<12 months) and those with la recurterence (>12 months) or no recurrence was performed using univariate and multivariate analyses.to the NCI-CTCAE criteria) acute kidney injury (AKI) occurred at a rate of 10.6% in our patient population.We propose a series of renal protective measures to eliminate highade grade AKI in patients who receive HIPEC with cisplatin. MethodsIn this prospective study, we instituted a protocol of renal protective measures and evaluated its effectiveness in preventing post-operative AKI.The 4 main pillars included:1. Adopting renal-adjusted dosing guidelines using pre-operative creatinine clearance for the dosing of intraoperative intraperitoneal cisplatin.2.Aggressive intra-and post-operative hydration with balanced crystalloids, aiming for a minimum of 2 ml/kg/hour of urin output.3.Decreasing of HIPEC temperature to 39 degrees celsius.4.Simultaneous intravenous infusion of sodium thiosulfate (STS), starting during initiation of HIPEC with a loading dose of 7.5 gm/m2 for 20 minutes, followed by a 12 hour maintenance dose of 15.3 gm/m2. ResultsThis protocol was administered to 23 consecutive patients undergoing HIPEC with cisplatin.All had normal renal function pre-operatively.Post-HIPEC, none of our patients developed high-grade AKI. 4 patients (17%) developed grade 1 AKI and the rest (19) retained normal renal function during their hospitalization.The creatinine levels of all patients returned to baseline at time of discharge, and remained normal on subsequent outpatient visits. ConclusionThis initial small phase 1 cohort study shows that a multi-pronged approach using tailored cisplatin doses, lowered temperature, agressive peri-operative hydration, and renal neutralization of cisplatin with sodium thiosulfate, is a useful protocol that can potentially significantly reduce the incidence of post-HIPEC AKI. E03

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Additional details

Additional titles

Translated title (Arabic)
II.e) النقائل البريتونية من سرطان المبيض
Translated title (English)
II.e) Peritoneal metastases from ovarian carcinoma
Translated title (French)
II.e) Métastases péritonéales du carcinome ovarien
Translated title (Spanish)
II.e) Peritoneal metastases from ovarian carcinoma

Identifiers

Other
https://openalex.org/W4233943764
DOI
10.1515/pp-2018-7020

Is supplement to
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https://openalex.org/W2169394819 (Other)
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GreSIS Basics Section

Is Global South Knowledge
Yes
Country
Mexico