Peritoneal Surface Malignancy Guidelines Prioritize Enhanced Representation

New Guidelines aim to Improve peritoneal Surface Malignancy Care

New guidelines for the management of peritoneal surface malignancy, developed by a team at Yale Cancer Center, represent a significant step forward in standardizing care and improving outcomes for patients. These guidelines build upon the 2018 Chicago Consensus but address its limitations with a more comprehensive and rigorous approach.

According to Kiran Turaga, MD, MPH, professor of surgical oncology and research lead for the project, the updated guidelines are “much larger,” incorporate input from patient representatives, and have received endorsements from the Society of Surgical Oncology. Crucially, they have also been adopted into the National Comprehensive Cancer Network (NCCN) guidelines, increasing their potential impact.

Addressing Gaps in Training and Care

A key focus of the new guidelines is improving the training of oncologists specializing in this complex disease. A core strategy is the adoption of common terminology to facilitate better understanding and dialog among trainees and specialists.

The 2018 Chicago Consensus aimed to reduce variability in care and promote a more patient-centric approach, but its impact was limited by a lack of widespread adoption into national guidelines. This time, the development process was considerably more robust.

A Rigorous and Inclusive Process

The new guidelines where developed through a rigorous Delphi process,involving rapid reviews akin to systematic reviews for each disease. The research team included experts from various disciplines – surgical oncologists, medical oncologists, and pathologists – as well as representatives from patient advocacy groups and international stakeholders.

“The key difference was that we also had patient representatives,” explained Dr. Turaga.”Every disease site had a patient group that represented their perspective and stakeholders.”

The inclusion of patient perspectives, combined with the methodological rigor and alignment with major national organizations, sets these guidelines apart from previous efforts.

Reference

Butensky SD, Bansal VV, Su DG, et al. Consensus guideline for the management of gastric cancer with synchronous peritoneal metastases.Ann Surg Oncol. Published online June 25, 2025. doi:10.1245/s10434-025-17361-2

How do the updated PSM guidelines address historical underrepresentation in clinical trials, and what specific strategies are being promoted to ensure greater inclusivity?

Peritoneal Surface Malignancy Guidelines Prioritize Enhanced Portrayal

Understanding the Shift in Peritoneal Cancer Treatment

Recent updates to peritoneal surface malignancy (PSM) guidelines are placing a important emphasis on enhanced representation – not just in clinical trials, but also in diagnostic pathways and treatment access. This evolution reflects a growing understanding of the complexities of PSM, encompassing conditions like peritoneal carcinomatosis, appendiceal cancer, ovarian cancer with peritoneal spread, and other rare malignancies affecting the peritoneum. Historically, these cancers have been underrepresented in research, leading to suboptimal treatment strategies. The goal now is to rectify this imbalance and improve outcomes for patients facing these challenging diagnoses.

Why Enhanced Representation Matters in PSM

For years, PSM presented a diagnostic and therapeutic hurdle. Often misdiagnosed or treated with generalized approaches, patients experienced poorer prognoses. Enhanced representation addresses this through several key avenues:

Improved Diagnostic accuracy: Increased awareness and specialized training for pathologists and radiologists are crucial. This leads to more accurate identification of PSM subtypes,impacting treatment decisions. Peritoneal biopsy and advanced imaging techniques like multiphase CT scans and MRI are becoming standard for accurate staging.

Clinical Trial Diversity: Historically,clinical trials have lacked diversity,failing to adequately represent different ethnicities,age groups,and co-morbidities. new guidelines actively promote inclusive trial designs to ensure findings are generalizable to the broader patient population.

Standardized reporting: The adoption of standardized reporting criteria, such as the Peritoneal Cancer Index (PCI), allows for consistent assessment of disease burden and response to treatment. This facilitates meaningful comparisons between studies and improves data analysis.

Multidisciplinary Team Approach: Effective PSM management requires a collaborative effort. Guidelines now strongly advocate for multidisciplinary tumor boards (MDTs) comprising surgical oncologists, medical oncologists, radiologists, pathologists, and specialized nurses.

The Role of Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

Cytoreductive surgery (CRS), combined with hyperthermic intraperitoneal chemotherapy (HIPEC), remains the cornerstone of treatment for many PSM cases. Though, the guidelines now emphasize:

Centralized Referral: Patients suspected of having PSM should be referred to specialized centers with expertise in CRS and HIPEC. This ensures access to the most appropriate and effective treatment.

Careful Patient Selection: Not all patients are suitable candidates for CRS/HIPEC.Guidelines outline specific criteria for patient selection, considering factors like performance status, disease extent, and prior treatments.

Surgical Precision: Complete cytoreduction (CC0) – the removal of all visible disease – is the primary goal of CRS. The guidelines highlight the importance of meticulous surgical technique and specialized training for surgeons performing these complex procedures.

HIPEC Protocol Optimization: The optimal HIPEC protocol (chemotherapy drugs, temperature, and dwell time) varies depending on the primary tumor type and disease characteristics. Guidelines provide recommendations based on the latest evidence.

Emerging Biomarkers and Personalized Medicine in PSM

The future of PSM treatment lies in personalized medicine. Research is actively exploring biomarkers that can predict treatment response and identify patients who are most likely to benefit from CRS/HIPEC. Key areas of examination include:

microsatellite Instability (MSI): MSI-high tumors may be more responsive to immunotherapy.

DNA Mismatch Repair (dMMR): Similar to MSI, dMMR status can predict immunotherapy benefit.

Gene Expression Profiling: Identifying specific gene signatures associated with aggressive disease or treatment resistance.

Liquid Biopsies: Analyzing circulating tumor cells (CTCs) and circulating tumor DNA (ctDNA) to monitor treatment response and detect recurrence.

benefits of Adhering to Updated PSM Guidelines

Implementing these updated guidelines offers several significant benefits:

Improved Survival Rates: Accurate diagnosis, appropriate treatment selection, and access to specialized care can lead to improved survival outcomes.

Enhanced Quality of Life: Effective treatment can alleviate symptoms and improve the quality of life for patients with PSM.

Reduced Healthcare Costs: Avoiding misdiagnosis and unnecessary treatments can reduce healthcare costs.

Accelerated Research: Standardized data collection and reporting facilitate research and accelerate the growth of new therapies.

Practical Tips for Patients and Healthcare Professionals

For Patients:

Seek a second opinion from a specialist experienced in PSM.

Ask your doctor about the possibility of referral to a specialized center.

Participate in clinical trials if eligible.

Advocate for your own health and be an active participant in your treatment decisions.

For Healthcare Professionals:

Stay up-to-date on the latest PSM guidelines.

consider PSM in the differential diagnosis of patients with abdominal pain, ascites, or unexplained weight loss.

Refer suspected cases to a multidisciplinary tumor board.

Promote clinical trial enrollment and data