Systematic review on the efficacy of multimodal treatment of sarcomatosis with cytoreduction and intraperitoneal chemotherapy.

Background: Peritoneal sarcomatosis carries a dismal prognosis with median survival of 12 months and no 5-year survivors. The treatment for sarcomatosis has mostly been chemotherapy and surgery for palliation. Recently, cytoreduction (CRS) and intraperitoneal chemotherapy (IPC) has been tried as an alternative for improving regional control and survival, but the efficacy of this combined treatment is difficult to determine. The objective of this review is to evaluate all available evidence to determine the efficacy of this treatment modality.

Materials And Methods: Searches for studies published in peer-reviewed journals before October 2010 were carried out on 3 databases. The reference lists of all identified articles were reviewed for further relevant studies. Relevant studies were then evaluated by 3 investigators, and the quality of each study was assessed. Studies that met an established criterion were reviewed for clinical effectiveness with a tabulation of all results.

Results: Eight prospective and one randomized trial were available representing 240 patients treated with CRS and IPC. The median disease-free survival ranged from 2.3 to 22 months, median survival ranged from 5.5 to 39.6 months, and the 5-year survival ranged from 7% to 65%. The surgical morbidity varied from 9% to 44% and the mortality from 0% to 11%.

Conclusions: Based on the available data, this treatment approach is currently not recommended in the treatment of sarcomatosis except in experienced centers, in well-selected patients and as part of an experimental protocol.