Abstract：
BACKGROUND: Diffuse malignant peritoneal mesothelioma (DMPM) is a rare and aggressive primary peritoneal disease, with recommended treatment, in eligible patients, of a combination of complete cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). As treatment is multimodal, there is a wide heterogeneity of HIPEC protocols precluding clear comparisons. Standardization at an international level is required.
METHODS: The Peritoneal Surface Oncology Group International (PSOGI) designated a steering committee to produce consensus recommendations for HIPEC regimens, adapted to each etiology. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) methodology was used, based on a systematic review focused on main outcomes related to HIPEC regimens in DMPM patients and on the patient, intervention, comparator, and outcome (PICO) method to elaborate main questions. An opinion survey was added. Furthermore, a Delphi process was performed with voting from a panel of international experts.
RESULTS: Eleven questions were elaborated, including two for future research requirements and three to assess the HIPEC regimen preference of the panel. The level of evidence underlying questions was globally low. Overall, 75 (86%) and 67 (77%) of the 87 invited experts completed the vote at the first and second round, respectively. HIPEC following complete CRS was strongly supported by 88% of voters with no need to plan comparative studies with CRS alone for 61.2% of voters. Bi-drug regimens appeared to be preferred to mono-drug ones and cisplatin was globally favored. The opinion survey confirmed the combination of cisplatin and doxorubicin as the recommended regimen.
CONCLUSIONS: International consensus confirmed the indication of HIPEC following complete CRS in DMPM patients and recommended cisplatin-doxorubicin as the first-line HIPEC regimen.
METHODS: The Peritoneal Surface Oncology Group International (PSOGI) designated a steering committee to produce consensus recommendations for HIPEC regimens, adapted to each etiology. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) methodology was used, based on a systematic review focused on main outcomes related to HIPEC regimens in DMPM patients and on the patient, intervention, comparator, and outcome (PICO) method to elaborate main questions. An opinion survey was added. Furthermore, a Delphi process was performed with voting from a panel of international experts.
RESULTS: Eleven questions were elaborated, including two for future research requirements and three to assess the HIPEC regimen preference of the panel. The level of evidence underlying questions was globally low. Overall, 75 (86%) and 67 (77%) of the 87 invited experts completed the vote at the first and second round, respectively. HIPEC following complete CRS was strongly supported by 88% of voters with no need to plan comparative studies with CRS alone for 61.2% of voters. Bi-drug regimens appeared to be preferred to mono-drug ones and cisplatin was globally favored. The opinion survey confirmed the combination of cisplatin and doxorubicin as the recommended regimen.
CONCLUSIONS: International consensus confirmed the indication of HIPEC following complete CRS in DMPM patients and recommended cisplatin-doxorubicin as the first-line HIPEC regimen.
摘要：
背景：弥漫性恶性腹膜间皮瘤（DMPM）是一种罕见且侵袭性的原发性腹膜疾病，推荐的治疗方法，在符合条件的患者中，完全细胞减灭术（CRS）和腹腔热化疗（HIPEC）的组合。由于治疗是多模式的，HIPEC方案存在广泛的异质性,排除了明确的比较.需要国际一级的标准化。
方法：国际腹膜表面肿瘤学组织（PSOGI）指定了一个指导委员会，为HIPEC方案提出共识建议，适应每个病因。推荐等级,评估,发展,使用评估(等级)方法，基于针对DMPM患者和患者与HIPEC方案相关的主要结局的系统评价，干预，比较器,和结果(PICO)方法来阐述主要问题。添加了意见调查。此外，Delphi过程是在国际专家小组的投票下进行的。
结果：阐述了11个问题，包括两项用于未来研究要求，三项用于评估小组的HIPEC方案偏好。问题背后的证据水平在全球范围内很低。总的来说,87名受邀专家中有75名（86％）和67名（77％）在第一轮和第二轮投票中完成了投票，分别。完整的CRS之后的HIPEC得到了88％的选民的大力支持，无需计划仅对61.2％的选民进行CRS的比较研究。双药方案似乎优于单药方案，顺铂在全球范围内受到青睐。意见调查证实顺铂和多柔比星的组合是推荐的方案。
结论：国际共识确认了DMPM患者完全CRS后HIPEC的适应症，并推荐顺铂-阿霉素作为一线HIPEC方案。
方法：国际腹膜表面肿瘤学组织（PSOGI）指定了一个指导委员会，为HIPEC方案提出共识建议，适应每个病因。推荐等级,评估,发展,使用评估(等级)方法，基于针对DMPM患者和患者与HIPEC方案相关的主要结局的系统评价，干预，比较器,和结果(PICO)方法来阐述主要问题。添加了意见调查。此外，Delphi过程是在国际专家小组的投票下进行的。
结果：阐述了11个问题，包括两项用于未来研究要求，三项用于评估小组的HIPEC方案偏好。问题背后的证据水平在全球范围内很低。总的来说,87名受邀专家中有75名（86％）和67名（77％）在第一轮和第二轮投票中完成了投票，分别。完整的CRS之后的HIPEC得到了88％的选民的大力支持，无需计划仅对61.2％的选民进行CRS的比较研究。双药方案似乎优于单药方案，顺铂在全球范围内受到青睐。意见调查证实顺铂和多柔比星的组合是推荐的方案。
结论：国际共识确认了DMPM患者完全CRS后HIPEC的适应症，并推荐顺铂-阿霉素作为一线HIPEC方案。
