Pseudomyxoma Survivor are proud to have sponsored the recent PMP Patients' Meeting which was held in Basingstoke in May 2013. The first meeting of its kind in the UK, attendees heard sessions from Dr Paul Sugarbaker and patient advocates Amani Albedah, Dave Mason and Pseudomyxoma Survivor's very own Dawn Green as well as attending breakout sessions which covered a range of topics.
Dr Sugarbaker spoke of the history of PMP. He introduced us to the history of the Peritoneal Surface Oncology Group International (PSOGI) and explained that "psogi" is also the Japanese for 'clear'. He talked through the different techniques of administering chemotherapy - during surgery and post, intravenous and intraperitoneal - and the efficacy of these methods. The key message was that survival statistics show a direct correlation to complete cytoreduction during surgery (1).
He also introduced the topic of long-term intraperitoneal chemotherapy, a treatment not usually seen in the UK. Dr Sugarbaker described a study carried out with ovarian cancer patients where the quality of life (QOL) was significantly worse in the intraperitoneal-therapy group before cycle 4 and three to six weeks after treatment but not one year after treatment (2).
Dr Sugarbaker then went on to talk about the history of heated intraperitoneal chemotherapy (HIPEC) with a key point of interest being the designation of the pseudomyxoma peritonei treatment center for the United Kingdom at the North Hampshire Hospital, Basingstoke, England in 1998. He explained the use of the Peritoneal Cancer Index (PCI) where a score is given as a summation of scores for areas of the abdomen based on tumour size and described studies which showed survival by PCI for both adenomucinosis and mucinous carcinoma.
We were then introduced to the CC score which is used after surgery:
- CC0 - No disease
- CC1 - tumours present but less than 0.25cm
- CC2 - tumours between 0.25cm -> 2.5cm
- CC3 - tumours larger than 2.5cm
and again, Dr Sugarbaker described studies showing survival by CC for both adenomucinosis and mucinous carcinoma.
Dr Sugarbaker then told us of the development of Peritoneal Surface Oncology treatment centres in the UK. The importance of a treatment center in the United
Kingdom for pseudomyxoma peritonei patients was made clear. In 1998 this became a reality with the establishment of the centre in Basingstoke. In 2002 a second center was established under the direction of Sarah O’Dwyer and colleagues in Manchester, UK. Other designated treatment centres have appeared throughout Europe.
Dr Sugarbaker described the incidents that cause issues following surgery and those which cause patients to have to have a further operation.
Of most interest to many attending was Dr Sugarbaker's discussion of the future direction for patients. He summarised these as follows:
- Abandon the watch-and-wait policy with referral of symptomatic patients to a peritoneal surface oncology centre.
- The preoperative treatments are now bidirectional with some chemotherapy agents for use with heat targeting to the peritoneal cavity - this is the use of both intravenous and intraperitoneal chemotherapy before surgery. Others as part of a hyperthermic intraoperative intraperitoneal chemotherapy regimen (HIPEC).
- Neoadjuvant treatments (treatments that are given before a main treatment) are now being explored for gastric cancer, presenting an exciting new direction for a group of patients with very poor prognosis.
- Perioperative (during a surgical procedure) chemotherapy is being moved to the primary management of gastrointestinal and gynecologic cancer.
(1)Youssef et al. Operative findings, early complications, and long-term survival in 456 patients with pseudomyxoma peritonei syndrome of appendiceal origin. Dis Colon Rectum 2011
(2) Intraperitoneal Cisplatin and Paclitaxel in Ovarian Cancer Armstrong DK et al. NEJM 2006