Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Metastasis from Breast Cancer: A Preliminary Report on 4 Cases

Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Metastasis from Breast Cancer: A Preliminary Report on 4 Cases | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Research Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Metastasis from Breast Cancer: A Preliminary Report on 4 Cases Jun-Hui Yu, Yu Feng, Xin-Bao Li, Cheng-Yan Zhang, Feng Shi, Song-Lin An, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-31253/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 01 Apr, 2021 Read the published version in Gland Surgery → Version 1 posted You are reading this latest preprint version Abstract Background: Breast cancer (BC) has been ranked as the first malignancy most common and the fifth in mortality rate among women in China [1]. Peritoneal metastases from BC is a rare disease and no guideline or international consensus for it. Objective: To summarize our experiences in cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) to treat breast cancer peritoneal carcinomatosis (BC PC). Methods: This is a retrospective study on the 4 BC PC patients underwent CRS+HIPEC at our center. The clinicopathological features and treatment details on the BC PC patients were analyzed. Result: The average age at CRS+HIPEC was 59.8 years. The average duration of CRS+HIPEC was 8.8 h. The median number of resected organ areas was 7. Overall survival from CRS+HIPEC were 31, 28, 16 and 52 months. There were no serious adverse events (SAEs) during perioperative period. Conclusions: The 4 cases provided evidence that integrated therapy with CRS+HIPEC may be a promising strategy to improve outcome for BC PC patients. Cancer Biology Oncology Breast cancer Peritoneal carcinomatosis Cytoreductive surgery Hyperthermic intraperitoneal chemotherapy Figures Figure 1 Figure 2 Figure 3 Figure 4 Background Breast cancer (BC) has been ranked as the first malignancy in incidence and the fifth mortality rate among women in China [1]. The most common metastasis sites of primary BC with invasive ductal carcinoma (IDC) include regional lymph nodes, bones, liver, lung, brain, and skin and with invasive lobular carcinoma (ILC) frequently affect bones, gynecological organs, peritoneum, retroperitoneum and gastrointestinal (GI) tract [2–3]. While management of recurrent BC is a therapeutic challenge, 5-year survival has steadily been increasing [4–5] in recent years. But peritoneal metastasis from BC is a poorly defined entity [6]. Current literatures provide scarce information on its management and no guideline or international consensus for it. Here we report 4 BC PC cases with multiple therapeutic modalities including cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). In order to determine the role of CRS+HIPEC in BC PC. Patients And Methods Clinical information From January 2015 to March 2020, a total of 893 BC patients have underwent radical resection at Beijing Shijitan Hospital, 17 of which have a progressive disease with PC. There are 4 BC PC patients underwent CRS + HIPEC enrolled in this retrospective study. The diagnosis of BC PC is confirmed by pathology in all patients. The study design was approved by the Ethical Committee of the Beijing Shijitan Hospital. All patients and their authorized caretakers were well educated about the CRS + HIPEC procedures and standardized informed consent forms were signed from the patients or their authorized caretakers. Major inclusion criteria: (1) patients had a clinical picture of BC PC and pathological confirmation; (2) Karnofsky performance status (KPS) score ≥ 60; (3) normal peripheral blood white blood cells count ≥ 3.5 × 10 9 /L and platelet count ≥ 80 × 10 9 /L; (4) acceptable liver function, with bilirubin ≤2 × the upper limit of normal (ULN) and aspartic aminotransferase and alanine aminotransferase ≤ 2 × ULN; (5) acceptable renal function, with serum creatinine ≤ 1.2 × ULN; and (6) cardiovascular pulmonary and other major organ functions could stand major operation. Major exclusion criteria: (1) serum bilirubin, aspartic aminotransferase and alanine aminotransferase level > 2 × ULN; (2) serum creatinine level > 1.2 × ULN; (3) imaging examination indicating significant mesenteric contracture; (4) the general status and major organ functions cannot stand major operation [7]. CRS + HIPEC procedure All CRS + HIPEC procedures were conducted by a designated team focusing on PC treatment. After general anesthesia, the midline incisions were performed from the xiphoid to the pubic symphysis. And then the disseminated extent of peritoneal metastases was explored from diaphragm peritoneum to pelvic peritoneum. The detail contents consisting of the nature and amount of ascites, the location and size of the tumor, were recorded. Based on the above, peritoneal cancer index (PCI) was evaluated [8] (Fig. 1 A). Subsequently, maximal CRS was performed, including the curative or palliative resection of the metastasis tumor with acceptable margins, lymphadenectomy, peritonectomies where peritoneal surfaces were involved by tumor, according to the peritonectomy procedures by Sugarbaker [9]. After CRS, completeness of cytoreduction (CC) was evaluated based on the size of residual tumor [10](Fig. 1 B). HIPEC was implemented by the open Colliseum technique with each drug dissolved into 3 L of heated saline with temperature 43 ± 0.5 ℃, the duration of HIPEC for each drug was 30 min with a flow rate of 400 ml/min. The HIPEC regimen consisted of cisplatin 120 mg plus docetaxel 120 mg. The reconstruction of the digestive tract or urinary tract, and the intestinal stoma, would be performed after HIPEC. And then abdominal drainage tubes were placed, and the incision sutured with reduced tension. Study endpoint The primary endpoints of this study was the overall survival from CRS+HIPEC. The secondary endpoint was the perioperative safety of CRS+HIPEC in BC PC. Definition Overall survival (OS) was calculated from the day of CRS+HIPEC to the date of death related with BC PC or the last follow-up. Perioperative period was defined from the day of CRS+HIPEC to the postoperative 30th day. Follow-up The frequency of follow up was arranged as follows: (1) once three months within 2 years after CRS+HIPEC; (3) once six months beyond 2 years after CRS+HIPEC. The follow-up consisted of general status, tumor response evaluation and survival information. The last follow-up by telephone or outpatient clinic was on March 1, 2020, with the rate of 100%. Results Major clinicopathological characteristics All 4 patients were female. The average age at CRS + HIPEC was 59.8 years (range: 50–65). In terms of pathology, there were 1 case with ILC and 3 cases with IDC. Molecular typing of primary tumors of all 4 cases was Luminal B. The major clinicopathological characteristics of 4 patients with primary breast tumor and peritoneal metastases were showed in Table 1. Characteristics Case 1 Case 2 Case 3 Case 4 Age at diagnosis of breast cancer, years 50 60 53 50 Gender Female Female Female Female Breast tumor localization Left Right Right Left Most extensively performed breast surgery Modified radical mastectomy Breast segment resection Modified radical mastectomy Modified radical mastectomy Breast tumor histological subtype ILC 1 IDC 2 IDC 2 IDC 2 Scarff-Bloom-Richardson grade Ⅱ Ⅱ II Ⅰ Tumor stage T2 T2 T2 T2 Nodal stage N2 N2 N0 N0 Metastasis 0 1 0 1 TNM stage IIIa IV IIa IV Estrogen receptor (Primary tumor/Metastasis tumor) Positive / Positive Positive / Positive Positive / Positive Positive / Positive Progesterone receptor (Primary tumor/Metastasis tumor) Positive / Positive Positive / Negative Negative / Negative Negative / Positive Her2/neu receptor (Primary tumor/Metastasis tumor) Negative / Negative Positive / Positive Negative / Negative Negative / Negative Ki-67 (Primary tumor/Metastasis tumor) (%) 20/30 50/50 25/50 90/20 Molecular subtypes (Primary tumor) Luminal B Luminal B Luminal B Luminal B Postoperative pathology ILC 1 IDC 2 IDC 2 IDC 2 Age at diagnosis of peritoneal metastases, years 64 60 65 50 Time between breast cancer and peritoneal metastases, months 174 0 120 0 Clinical presentation Abdominal distension Frequent urination, constipation and abdominal pain Abdominal pain and abdominal distension Left breast mass and abdominal distension Diagnosis of peritoneal metastasis Postoperative pathology Postoperative pathology Postoperative pathology Needle biopsy 1. Invasive lobular carcinoma 2. Invasive ductal carcinoma Table 1 Major clinicopathological characteristics of 4 patients with primary breast tumor and peritoneal metastases Major CRS + HIPEC characteristics The average duration of CRS + HIPEC was 8.8 h (range: 7 - 10.6 h). The median number of resected organs was 7 (range: 5 - 9). The average blood loss was 525 ml (range: 400 - 800 ml). The average ascites volume was 3,625 ml (range: 1,000 - 10,000 ml). In regard to HIPEC regimen, all 4 cases were with docetaxel 120 mg plus cisplatin 120 mg. The average PCI was 29.5 (range: 21 - 39). There were 2 cases with CC 0 and 2 cases with CC 3. The major clinicopathological characteristics of CRS+HIPEC were showed in Table 2. Characteristics Case 1 Case 2 Case 3 Case 4 Peritoneal cancer index (PCI) 39 28 21 30 Completeness of cytoreduction (CC) 3 3 0 0 Karnofsky performance status (KPS) 80 80 80 80 Blood loss (ml) 400 800 400 500 Rang of operation Omentum, uterus, bilateral fallopian tubes, ovary, bladder tumor, hepatic round ligament, abdominal wall mass abdominal wall tumor, intestinal repair, omentum, retroperitoneal tumor , breast segment rectal, mesenteric, appendectomy, small bowel, diaphragm lesions, omentum lesion, total hysterectomy, bowel repair, omentectomy and pelvic lymphadenectomy total uterus, double attachment, omentum, para-aortic lymph nodes, pelvic lymph nodes Chemotherapy drugs for HIPEC Docetaxel + Cisplatin Docetaxel + Cisplatin Docetaxel + Cisplatin Docetaxel + Cisplatin Operation duration (h) 7.0 10.6 9.0 8.5 HIPEC duration (min) 60 60 60 60 Ascites volume (ml) 10000 2000 1000 1500 Ascites properties Light yellow slightly turbid Light yellow Yellow turbid Light yellow Postoperative treatment Letrozole Docetaxel Trastuzumab Letrozole Docetaxel plus carboplatin IV Letrozole Paclitaxel+ carboplatin IP Chest wall radiotherapy Letrozole Operative complications NO NO NO NO Average hospital stay after CRS + HIPEC (d) 15 10 21 12 Overall survival from diagnosis BC (OS 1 ) (month) 205 28 136 52 Overall survival from CRS+HIPEC (OS 2 ) (month) 31 28 16 52 Table 2 Major clinicopathological characteristics of CRS+HIPEC OS and safety analysis All 4 patients were alive and overall survival from CRS+HIPEC were 31, 28, 16 and 52 months, respectively. Overall survival from diagnosis BC was 205, 28, 136 and 52 months, respectively. (Table 2) There were no serious adverse events (SAEs) during perioperative period. Discussion Our study demonstrates that patients with BC PC can benefit from CRS+HIPEC. CRS+HIPEC not only improves quality of life, but also extends overall survival. There are no SAEs during CRS+HIPEC perioperative period. PC usually originated from gastrointestinal tumor and female gynecological tumor. Typical metastasis sites of BC were bones, lungs, liver and brain. Many other sites had been described in the literatures, including the peritoneal metastases [11], with 0.7% of the prevalence of peritoneal metastases [12]. The data about peritoneal and gastrointestinal metastases of BC was lack in the literatures. ILC accounts for 6% to 10% of all BCs. It has a different metastatic pattern if compared with IDCs, probably due to the loss of E-cadherin expression on tumor cell membrane that promotes tumor cell migration and prevents cell to cell adhesion [13]. Peritoneal metastases was a significant cause of morbidity and mortality from both IDC and ILC. Compared to 3% of patients diagnosed with IDC, up to 11% of ILC patients had peritoneal metastases diagnosed with CT and operative reports ( P = 0.006) [14]. In this study, there were 3 patients with IDC and 1 patients with ILC of the primary BC (Fig. 2 - 4). The metastasis tumor was the same as the primary tumor. For what concerns the prognosis of metastatic BC, peritoneal metastases showed a very poor survival. The median survival from diagnosis of the patients with metastatic BC was 20.5 months but the median survival of patients with peritoneal metastases was extremely poor at only 1.56 months [15]. Another study showed the overall survival from the diagnosis of metastases was 5.8 months in patients with peritoneal metastases as compared to 22.6 months in metastatic BC patients with no peritoneal involvement. Patients with metachronous metastases had significantly poorer survival than patients with synchronous metastases [16]. There were 2 cases with metachronous metastases and 2 case with synchronous metastases in our study. The OS of the synchronous metastases’ patients had reached 28 months and the longest OS of the metachronous metastases had reached 52 months to March, 2020. BC PC caused abdominal distension, abdominal pain or severe intestinal obstruction. And all patients in our study had at least one of the above symptoms. However, there were no effective treatments to relieve these symptoms and chronic malnutrition caused poor prognosis. The traditional treatment methods for BC PC were chemotherapy or radiotherapy and patients had poor survival. The treatment of BC PC in this study was chemotherapy combined with CRS+HIPEC. In order to achieve a radical CRS, the median number of resected organs were 7 and 2 patients reached CC 0. The tolerance to hyperthermia was higher in normal tissue than the tumor tissue. HIPEC could prevent the adhesion postoperatively, as well as decrease the accelerative effect of healing on tumor cell entrapment by killing the granulocytes and monocytes. The synergistic anti-cancer effect could be dramatically increased at 43℃. Hyperthermia could increase the response rates of cancer cells to HIPEC drugs, and the depth of HIPEC drugs into the tumor tissues. At last, loosening the adhesion of the intestine or ileostomy could relieve intestinal obstruction. In our study, one case underwent loosening the adhesion of the intestine, and another underwent ileostomy, the abdominal distension or bowel obstruction of which relieved completely. All patients received adjuvant chemotherapy and endocrine therapy pre- and post-CRS+HIPEC, with 32 months of the average OS, which was better than literatures. Estrogen played an important stimulatory role in the normal breast and in the development and progression of BC. The estrogen receptor (ER) was one of the most important prognostic biomarkers in BC [17]. ER- and progesterone receptor (PR)- positive cases had the best outcome usually [18]. Human epidermal growth factor receptor 2 (HER–2 , erbB–2) was a transmembrane tyrosine kinase receptor that regulates cell growth, proliferation, and survival [19]. HER–2 gene amplification was a strong prognostic biomarker for an aggressive clinical course [20]. Ki–67 was a nuclear proliferation marker. In general, BC with high levels of Ki67 correlated with worse outcomes [21]. In our study, two patients with synchronous BC PC, one with Ki–67 80–90% and another with HER–2 positive, may be one of the reasons for the early peritoneal metastasis. The other two cases received standard adjuvant therapy after the primary lesion. All patents received tamoxifen treatment for 5 years and metastasis occurred after 5 years of discontinuation (all 4 cases had positive estrogen receptors). So it was important for hormone receptor positive BC PC patients. At present, all the 4 patients had received letrozole orally after CRS+HIPEC and chemotherapy. No tumor progression occurred at the time of follow-up. The average PCI was 29.5, which heralded the difficulty of CRS. The average duration was 8.8 h, the median number of resected organs was 7, the average blood loss was 525 ml and the average ascites volume was 3,625 ml. While there were no SAEs during perioperative period and the average hospital stay was 15 d. The safety of CRS+HIPEC was accepted. It was important that a designated team focusing on PC treatment implemented standardized CRS+HIPEC. Otherwise you maybe come to the opposite conclusion that CRS+HIPEC were not the treatment of choice [22]. This article provided new ideas and methods for the treatment of a large number of BC PC patients. The disadvantage of this study was that the number of patients was too small to perform statistical analysis. The follow up time was short. Therefore, these findings in this study required more confirmations from large sample of evidence. Conclusions This paper reported 4 typical cases of BC PC successfully treated by a radical comprehensive treatments with CRS + HIPEC. These patients kept in good condition till now, with 32 months of mean overall survival since CRS+HIPEC. The 4 cases provided evidence that integrated therapy with CRS+HIPEC may be a promising strategy to improve outcome for BC PC patients. List Of Abbreviations Abbreviations Full name BC Breast cancer CRS Cytoreductive surgery HIPEC Hyperthermic intraperitoneal chemotherapy PC Peritoneal carcinomatosis BC PC Breast cancer peritoneal carcinomatosis SAEs Serious adverse events IDC Invasive ductal carcinoma ILC Invasive lobular carcinoma GI Gastrointestinal KPS Karnofsky performance status ULN Upper limit of normal PCI Peritoneal cancer index CC Completeness of cytoreduction OS Overall survival ER Estrogen receptor PR Progesterone receptor HER-2 Human epidermal growth factor receptor 2 Declarations Ethics approval and consent to participate Not applicable. Consent for publication Written informed consent was obtained from the 4 patients for publication of this article and accompanying images. A copy of these written consent is available for review by the Editor-in-Chief of this journal. Availability of data and material The datasets used and analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This work was supported by the Beijing Municipal Administration of Hospital Ascent Plan (DFL20180701); Beijing Municipal Grant for Medical Talents Group on Peritoneal Surface Oncology (2017400003235J007) (both to Yan Li). Authors' contributions Jun-hui Yu organized the patient's medical records and was the major contributor in writing the manuscript. Yu Feng, Xin-bao Li and Yan-Ping Li collected the patient's medical records. Cheng-Yan Zhang and Feng Shi collected the patient's pathological pictures. Song-Lin An, Gang Liu, Yan-Bin Zhang, Kai Zhang, Zhong-He Ji, Bing Li and Guo-Jun Yan conducted the procedures of CRS + HIPEC. Yan Li designed the project, monitored project progress, and contributed to data evaluation of the manuscript. 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Peritoneal metastases from breast cancer: a scoping review. Cureus. 2019; 11(8): e5367. Cite Share Download PDF Status: Published Journal Publication published 01 Apr, 2021 Read the published version in Gland Surgery → Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-31253","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research","associatedPublications":[],"authors":[{"id":608054,"identity":"30202d6f-aacc-4951-a0be-5b3f5a56004c","order_by":0,"name":"Jun-Hui Yu","email":"","orcid":"","institution":"Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jun-Hui","middleName":"","lastName":"Yu","suffix":""},{"id":608055,"identity":"4b01ab18-ae35-4400-a669-dd350b0b89a0","order_by":1,"name":"Yu Feng","email":"","orcid":"","institution":"Department of 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15:21:01","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-31253/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-31253/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.21037/gs-20-893","type":"published","date":"2021-04-01T21:02:30+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":1211413,"identity":"7efc668c-422e-48e4-80b5-942734c7e141","added_by":"auto","created_at":"2020-05-29 18:44:31","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":473702,"visible":true,"origin":"","legend":"Peritoneal cancer index score (A) and completeness of cytoreduction score (B).","description":"","filename":"Fig1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-31253/v1/Fig1.jpg"},{"id":1211414,"identity":"086fffbb-fb0e-4401-9786-d3ab31ee72e6","added_by":"auto","created_at":"2020-05-29 18:44:31","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":923448,"visible":true,"origin":"","legend":"Preoperative image examination. A: Massive ascites and omentum contraction; B: Small intestine contraction; C: Peritoneal thickening; D: Pelvic tumor with contrast enhancement; E: Coronal showed Massive ascites; omentum contraction and small intestine contraction; F: Total gastrointestinal angiography showed the gathered small intestine.","description":"","filename":"Fig2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-31253/v1/Fig2.jpg"},{"id":1211415,"identity":"ff5c0bc2-5cf8-4034-ab42-a936988069b9","added_by":"auto","created_at":"2020-05-29 18:44:31","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":1206054,"visible":true,"origin":"","legend":"CRS intraoperative and postoperative specimens. A: Omentum contraction; B: Tumor nodules on the omentum; C: Small intestine contraction and tumor nodules on the mesentery; D: Postoperative specimens.","description":"","filename":"Fig3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-31253/v1/Fig3.jpg"},{"id":1211416,"identity":"b8821659-f226-4740-bb49-4d059b657df7","added_by":"auto","created_at":"2020-05-29 18:44:32","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":2156362,"visible":true,"origin":"","legend":"Pathological classification of primary (A1 - A4) and metastasis (B1 - B4) breast tumors (hematoxylin-eosin staining). A1: Invasive lobular carcinoma of the breast; A2: Tumor cells have poor adhesion and scattered in a single or single row of infiltrating interstitium; A3: Tumor cells infiltrate the stroma in a single row and forming a linear structure; A4: Tumor cells have smaller but the same size. Some cytoplasm contains eosinophilic globules and the nucleus is eccentric, round, small nucleolus and pathological mitosis is rare. B1: Invasive lobular carcinoma metastasizes to the abdominal cavity and infiltrates into the peritoneal fibrous connectives; B2: Tumor cells have poor adhesion, diffuse, scattered in a single or single row of infiltrating interstitium; B3: Tumor cells infiltrate the stroma in a single row and forming a linear structure; B4: Tumor cells have the same size, nuclear round, small nucleoli are common and pathological mitosis is rare. The magnification of the pictures of the two line from the left to right are ×50, ×100, ×200 and ×400, respectively.","description":"","filename":"Fig4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-31253/v1/Fig4.jpg"},{"id":13533669,"identity":"3fda0472-5fcd-4ef3-b7d4-baa2ad5b4354","added_by":"auto","created_at":"2021-09-17 01:21:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1046432,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-31253/v1/86064862-2af2-468d-b4cc-39d56fd4298a.pdf"}],"financialInterests":"","formattedTitle":"Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Metastasis from Breast Cancer: A Preliminary Report on 4 Cases","fulltext":[{"header":"Background","content":"\u003cp\u003eBreast cancer (BC) has been ranked as the first malignancy in incidence and the fifth mortality rate among women in China [1]. The most common metastasis sites of primary BC with invasive ductal carcinoma (IDC) include regional lymph nodes, bones, liver, lung, brain, and skin and with invasive lobular carcinoma (ILC) frequently affect bones, gynecological organs, peritoneum, retroperitoneum and gastrointestinal (GI) tract [2–3]. While management of recurrent BC is a therapeutic challenge, 5-year survival has steadily been increasing [4–5] in recent years. But peritoneal metastasis from BC is a poorly defined entity [6]. Current literatures provide scarce information on its management and no guideline or international consensus for it.\u003c/p\u003e\n\u003cp\u003eHere we report 4 BC PC cases with multiple therapeutic modalities including cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). In order to determine the role of CRS+HIPEC in BC PC.\u003c/p\u003e"},{"header":"Patients And Methods","content":"\u003ch2\u003eClinical information\u003c/h2\u003e\n\u003cp\u003eFrom January 2015 to March 2020, a total of 893 BC patients have underwent radical resection at Beijing Shijitan Hospital, 17 of which have a progressive disease with PC. There are 4 BC PC patients underwent CRS + HIPEC enrolled in this retrospective study. The diagnosis of BC PC is confirmed by pathology in all patients.\u003c/p\u003e\n\u003cp\u003eThe study design was approved by the Ethical Committee of the Beijing Shijitan Hospital. All patients and their authorized caretakers were well educated about the CRS + HIPEC procedures and standardized informed consent forms were signed from the patients or their authorized caretakers.\u003c/p\u003e\n\u003cp\u003eMajor inclusion criteria: (1) patients had a clinical picture of BC PC and pathological confirmation; (2) Karnofsky performance status (KPS) score ≥ 60; (3) normal peripheral blood white blood cells count ≥ 3.5 × 10\u003csup\u003e9\u003c/sup\u003e/L and platelet count ≥ 80 × 10\u003csup\u003e9\u003c/sup\u003e/L; (4) acceptable liver function, with bilirubin ≤2 × the upper limit of normal (ULN) and aspartic aminotransferase and alanine aminotransferase ≤ 2 × ULN; (5) acceptable renal function, with serum creatinine ≤ 1.2 × ULN; and (6) cardiovascular pulmonary and other major organ functions could stand major operation. Major exclusion criteria: (1) serum bilirubin, aspartic aminotransferase and alanine aminotransferase level \u0026gt; 2 × ULN; (2) serum creatinine level \u0026gt; 1.2 × ULN; (3) imaging examination indicating significant mesenteric contracture; (4) the general status and major organ functions cannot stand major operation [7].\u003c/p\u003e\n\u003ch2\u003eCRS + HIPEC procedure\u003c/h2\u003e\n\u003cp\u003eAll CRS + HIPEC procedures were conducted by a designated team focusing on PC treatment. After general anesthesia, the midline incisions were performed from the xiphoid to the pubic symphysis. And then the disseminated extent of peritoneal metastases was explored from diaphragm peritoneum to pelvic peritoneum. The detail contents consisting of the nature and amount of ascites, the location and size of the tumor, were recorded. Based on the above, peritoneal cancer index (PCI) was evaluated [8] (Fig. 1 A). Subsequently, maximal CRS was performed, including the curative or palliative resection of the metastasis tumor with acceptable margins, lymphadenectomy, peritonectomies where peritoneal surfaces were involved by tumor, according to the peritonectomy procedures by Sugarbaker [9]. After CRS, completeness of cytoreduction (CC) was evaluated based on the size of residual tumor [10](Fig. 1 B). HIPEC was implemented by the open Colliseum technique with each drug dissolved into 3 L of heated saline with temperature 43 ± 0.5 ℃, the duration of HIPEC for each drug was 30 min with a flow rate of 400 ml/min. The HIPEC regimen consisted of cisplatin 120 mg plus docetaxel 120 mg.\u003c/p\u003e\n\u003cp\u003eThe reconstruction of the digestive tract or urinary tract, and the intestinal stoma, would be performed after HIPEC. And then abdominal drainage tubes were placed, and the incision sutured with reduced tension.\u003c/p\u003e\n\u003ch2\u003eStudy endpoint\u003c/h2\u003e\n\u003cp\u003eThe primary endpoints of this study was the overall survival from CRS+HIPEC. The secondary endpoint was the perioperative safety of CRS+HIPEC in BC PC.\u003c/p\u003e\n\u003ch2\u003eDefinition\u003c/h2\u003e\n\u003cp\u003eOverall survival (OS) was calculated from the day of CRS+HIPEC to the date of death related with BC PC or the last follow-up. Perioperative period was defined from the day of CRS+HIPEC to the postoperative 30th day.\u003c/p\u003e\n\u003ch2\u003eFollow-up\u003c/h2\u003e\n\u003cp\u003eThe frequency of follow up was arranged as follows: (1) once three months within 2 years after CRS+HIPEC; (3) once six months beyond 2 years after CRS+HIPEC. The follow-up consisted of general status, tumor response evaluation and survival information. The last follow-up by telephone or outpatient clinic was on March 1, 2020, with the rate of 100%.\u003c/p\u003e"},{"header":"Results","content":"\u003ch2\u003eMajor clinicopathological characteristics\u003c/h2\u003e\n\u003cp\u003eAll 4 patients were female. The average age at CRS + HIPEC was 59.8 years (range: 50–65). In terms of pathology, there were 1 case with ILC and 3 cases with IDC. Molecular typing of primary tumors of all 4 cases was Luminal B. The major clinicopathological characteristics of 4 patients with primary breast tumor and peritoneal metastases were showed in Table 1.\u003c/p\u003e\n\u003ctable border=\"1\" width=\"0\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"378\"\u003e\n\u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e\u003cstrong\u003eCase 1\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e\u003cstrong\u003eCase 2\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e\u003cstrong\u003eCase 3\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e\u003cstrong\u003eCase 4\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"378\"\u003e\n\u003cp\u003eAge at diagnosis of breast cancer, years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e50\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e60\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e53\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e50\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"378\"\u003e\n\u003cp\u003eGender\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"378\"\u003e\n\u003cp\u003eBreast tumor localization\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eLeft\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eRight\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eRight\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eLeft\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"378\"\u003e\n\u003cp\u003eMost extensively performed breast surgery\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eModified radical mastectomy\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eBreast segment resection\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eModified radical mastectomy\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eModified radical mastectomy\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"378\"\u003e\n\u003cp\u003eBreast tumor histological subtype\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eILC\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eIDC\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eIDC\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eIDC\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"378\"\u003e\n\u003cp\u003eScarff-Bloom-Richardson grade\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eⅡ\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eⅡ\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eII\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eⅠ\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"378\"\u003e\n\u003cp\u003eTumor stage\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eT2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eT2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eT2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eT2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"378\"\u003e\n\u003cp\u003eNodal stage\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eN2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eN2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eN0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eN0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"378\"\u003e\n\u003cp\u003eMetastasis\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"378\"\u003e\n\u003cp\u003eTNM stage\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eIIIa\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eIV\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eIIa\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eIV\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"378\"\u003e\n\u003cp\u003eEstrogen receptor (Primary tumor/Metastasis tumor)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003ePositive / Positive\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003ePositive / Positive\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003ePositive / Positive\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003ePositive / Positive\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"378\"\u003e\n\u003cp\u003eProgesterone receptor (Primary tumor/Metastasis tumor)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003ePositive / Positive\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003ePositive / Negative\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eNegative / Negative\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eNegative / Positive\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"378\"\u003e\n\u003cp\u003eHer2/neu receptor (Primary tumor/Metastasis tumor)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eNegative / Negative\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003ePositive / Positive\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eNegative / Negative\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eNegative / Negative\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"378\"\u003e\n\u003cp\u003eKi-67 (Primary tumor/Metastasis tumor) (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e20/30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e50/50\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e25/50\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e90/20\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"378\"\u003e\n\u003cp\u003eMolecular subtypes (Primary tumor)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eLuminal B\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eLuminal B\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eLuminal B\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eLuminal B\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"378\"\u003e\n\u003cp\u003ePostoperative pathology\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eILC\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eIDC\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eIDC\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eIDC\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"378\"\u003e\n\u003cp\u003eAge at diagnosis of peritoneal metastases, years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e64\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e60\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e65\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e50\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"378\"\u003e\n\u003cp\u003eTime between breast cancer and peritoneal metastases, months\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e174\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e120\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"378\"\u003e\n\u003cp\u003eClinical presentation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eAbdominal distension\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eFrequent urination, constipation and abdominal pain\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eAbdominal pain and abdominal distension\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eLeft breast mass and abdominal distension\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"378\"\u003e\n\u003cp\u003eDiagnosis of peritoneal metastasis\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003ePostoperative pathology\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003ePostoperative pathology\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003ePostoperative pathology\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eNeedle biopsy\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\" width=\"907\"\u003e\n\u003cp\u003e1. Invasive lobular carcinoma\u003cbr\u003e2. Invasive ductal carcinoma\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eMajor clinicopathological characteristics of 4 patients with primary breast tumor and peritoneal metastases\u003c/p\u003e\n\u003c/div\u003e\n\u003ch2\u003eMajor CRS + HIPEC characteristics\u003c/h2\u003e\n\u003cp\u003eThe average duration of CRS + HIPEC was 8.8 h (range: 7 - 10.6 h). The median number of resected organs was 7 (range: 5 - 9). The average blood loss was 525 ml (range: 400 - 800 ml). The average ascites volume was 3,625 ml (range: 1,000 - 10,000 ml). In regard to HIPEC regimen, all 4 cases were with docetaxel 120 mg plus cisplatin 120 mg. The average PCI was 29.5 (range: 21 - 39). There were 2 cases with CC 0 and 2 cases with CC 3. The major clinicopathological characteristics of CRS+HIPEC were showed in Table 2.\u003c/p\u003e\n\u003ctable border=\"1\" width=\"0\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"246\"\u003e\n\u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003e\u003cstrong\u003eCase 1\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"161\"\u003e\n\u003cp\u003e\u003cstrong\u003eCase 2\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003e\u003cstrong\u003eCase 3\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003e\u003cstrong\u003eCase 4\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"246\"\u003e\n\u003cp\u003ePeritoneal cancer index (PCI)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003e39\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"161\"\u003e\n\u003cp\u003e28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003e21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003e30\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"246\"\u003e\n\u003cp\u003eCompleteness of cytoreduction (CC)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"161\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"246\"\u003e\n\u003cp\u003eKarnofsky performance status (KPS)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003e80\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"161\"\u003e\n\u003cp\u003e80\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003e80\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003e80\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"246\"\u003e\n\u003cp\u003eBlood loss (ml)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003e400\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"161\"\u003e\n\u003cp\u003e800\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003e400\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003e500\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"246\"\u003e\n\u003cp\u003eRang of operation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003eOmentum, uterus, bilateral fallopian tubes, ovary, bladder tumor, hepatic round ligament, abdominal wall mass\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"161\"\u003e\n\u003cp\u003eabdominal wall tumor, intestinal repair, omentum, retroperitoneal tumor , breast segment\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003erectal, mesenteric, appendectomy, small bowel, diaphragm lesions, omentum lesion, total hysterectomy, bowel repair, omentectomy and pelvic lymphadenectomy\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003etotal uterus, double attachment, omentum, para-aortic lymph nodes, pelvic lymph nodes\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"246\"\u003e\n\u003cp\u003eChemotherapy drugs for HIPEC\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003eDocetaxel + Cisplatin\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"161\"\u003e\n\u003cp\u003eDocetaxel + Cisplatin\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003eDocetaxel + Cisplatin\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003eDocetaxel +\u0026nbsp; Cisplatin\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"246\"\u003e\n\u003cp\u003eOperation duration (h)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003e7.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"161\"\u003e\n\u003cp\u003e10.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003e9.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003e8.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"246\"\u003e\n\u003cp\u003eHIPEC duration (min)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003e60\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"161\"\u003e\n\u003cp\u003e60\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003e60\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003e60\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"246\"\u003e\n\u003cp\u003eAscites volume (ml)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003e10000\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"161\"\u003e\n\u003cp\u003e2000\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003e1000\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003e1500\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"246\"\u003e\n\u003cp\u003eAscites properties\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003eLight yellow slightly turbid\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"161\"\u003e\n\u003cp\u003eLight yellow\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003eYellow turbid\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003eLight yellow\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"246\"\u003e\n\u003cp\u003ePostoperative treatment\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003eLetrozole\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"161\"\u003e\n\u003cp\u003eDocetaxel\u003c/p\u003e\n\u003cp\u003eTrastuzumab\u003c/p\u003e\n\u003cp\u003eLetrozole\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003eDocetaxel plus\u0026nbsp; carboplatin IV\u003c/p\u003e\n\u003cp\u003eLetrozole\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003ePaclitaxel+ carboplatin IP\u003c/p\u003e\n\u003cp\u003eChest wall radiotherapy\u003c/p\u003e\n\u003cp\u003eLetrozole\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"246\"\u003e\n\u003cp\u003eOperative complications\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003eNO\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"161\"\u003e\n\u003cp\u003eNO\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003eNO\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003eNO\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"246\"\u003e\n\u003cp\u003eAverage hospital stay after CRS + HIPEC (d)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003e15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"161\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003e21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"246\"\u003e\n\u003cp\u003eOverall survival from diagnosis BC (OS\u003csub\u003e1\u003c/sub\u003e) (month)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003e205\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"161\"\u003e\n\u003cp\u003e28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003e136\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003e52\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"246\"\u003e\n\u003cp\u003eOverall survival from CRS+HIPEC (OS\u003csub\u003e2\u003c/sub\u003e) (month)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"189\"\u003e\n\u003cp\u003e31\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"161\"\u003e\n\u003cp\u003e28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003e16\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"170\"\u003e\n\u003cp\u003e52\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eMajor clinicopathological characteristics of CRS+HIPEC\u003c/p\u003e\n\u003c/div\u003e\n\u003ch2\u003eOS and safety analysis\u003c/h2\u003e\n\u003cp\u003eAll 4 patients were alive and overall survival from CRS+HIPEC were 31, 28, 16 and 52 months, respectively. Overall survival from diagnosis BC was 205, 28, 136 and 52 months, respectively. (Table 2)\u003c/p\u003e\n\u003cp\u003eThere were no serious adverse events (SAEs) during perioperative period.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur study demonstrates that patients with BC PC can benefit from CRS+HIPEC. CRS+HIPEC not only improves quality of life, but also extends overall survival. There are no SAEs during CRS+HIPEC perioperative period.\u003c/p\u003e\n\u003cp\u003ePC usually originated from gastrointestinal tumor and female gynecological tumor. Typical metastasis sites of BC were bones, lungs, liver and brain. Many other sites had been described in the literatures, including the peritoneal metastases [11], with 0.7% of the prevalence of peritoneal metastases [12]. The data about peritoneal and gastrointestinal metastases of BC was lack in the literatures.\u003c/p\u003e\n\u003cp\u003eILC accounts for 6% to 10% of all BCs. It has a different metastatic pattern if compared with IDCs, probably due to the loss of E-cadherin expression on tumor cell membrane that promotes tumor cell migration and prevents cell to cell adhesion [13]. Peritoneal metastases was a significant cause of morbidity and mortality from both IDC and ILC. Compared to 3% of patients diagnosed with IDC, up to 11% of ILC patients had peritoneal metastases diagnosed with CT and operative reports (\u003cem\u003eP\u003c/em\u003e = 0.006) [14].\u003c/p\u003e\n\u003cp\u003eIn this study, there were 3 patients with IDC and 1 patients with ILC of the primary BC (Fig. 2 - 4). The metastasis tumor was the same as the primary tumor.\u003c/p\u003e\n\u003cp\u003eFor what concerns the prognosis of metastatic BC, peritoneal metastases showed a very poor survival. The median survival from diagnosis of the patients with metastatic BC was 20.5 months but the median survival of patients with peritoneal metastases was extremely poor at only 1.56 months [15]. Another study showed the overall survival from the diagnosis of metastases was 5.8 months in patients with peritoneal metastases as compared to 22.6 months in metastatic BC patients with no peritoneal involvement. Patients with metachronous metastases had significantly poorer survival than patients with synchronous metastases [16].\u003c/p\u003e\n\u003cp\u003eThere were 2 cases with metachronous metastases and 2 case with synchronous metastases in our study. The OS of the synchronous metastases’ patients had reached 28 months and the longest OS of the metachronous metastases had reached 52 months to March, 2020.\u003c/p\u003e\n\u003cp\u003eBC PC caused abdominal distension, abdominal pain or severe intestinal obstruction. And all patients in our study had at least one of the above symptoms. However, there were no effective treatments to relieve these symptoms and chronic malnutrition caused poor prognosis. The traditional treatment methods for BC PC were chemotherapy or radiotherapy and patients had poor survival. The treatment of BC PC in this study was chemotherapy combined with CRS+HIPEC. In order to achieve a radical CRS, the median number of resected organs were 7 and 2 patients reached CC 0. The tolerance to hyperthermia was higher in normal tissue than the tumor tissue. HIPEC could prevent the adhesion postoperatively, as well as decrease the accelerative effect of healing on tumor cell entrapment by killing the granulocytes and monocytes. The synergistic anti-cancer effect could be dramatically increased at 43℃. Hyperthermia could increase the response rates of cancer cells to HIPEC drugs, and the depth of HIPEC drugs into the tumor tissues. At last, loosening the adhesion of the intestine or ileostomy could relieve intestinal obstruction. In our study, one case underwent loosening the adhesion of the intestine, and another underwent ileostomy, the abdominal distension or bowel obstruction of which relieved completely. All patients received adjuvant chemotherapy and endocrine therapy pre- and post-CRS+HIPEC, with 32 months of the average OS, which was better than literatures.\u003c/p\u003e\n\u003cp\u003eEstrogen played an important stimulatory role in the normal breast and in the development and progression of BC. The estrogen receptor (ER) was one of the most important prognostic biomarkers in BC [17]. ER- and progesterone receptor (PR)- positive cases had the best outcome usually [18]. Human epidermal growth factor receptor 2 (HER–2\u003csub\u003e, \u003c/sub\u003eerbB–2) was a transmembrane tyrosine kinase receptor that regulates cell growth, proliferation, and survival [19]. HER–2 gene amplification was a strong prognostic biomarker for an aggressive clinical course [20]. Ki–67 was a nuclear proliferation marker. In general, BC with high levels of Ki67 correlated with worse outcomes [21]. In our study, two patients with synchronous BC PC, one with Ki–67 80–90% and another with HER–2 positive, may be one of the reasons for the early peritoneal metastasis. The other two cases received standard adjuvant therapy after the primary lesion. All patents received tamoxifen treatment for 5 years and metastasis occurred after 5 years of discontinuation (all 4 cases had positive estrogen receptors). So it was important for hormone receptor positive BC PC patients. At present, all the 4 patients had received letrozole orally after CRS+HIPEC and chemotherapy. No tumor progression occurred at the time of follow-up.\u003c/p\u003e\n\u003cp\u003eThe average PCI was 29.5, which heralded the difficulty of CRS. The average duration was 8.8 h, the median number of resected organs was 7, the average blood loss was 525 ml and the average ascites volume was 3,625 ml. While there were no SAEs during perioperative period and the average hospital stay was 15 d. The safety of CRS+HIPEC was accepted. It was important that a designated team focusing on PC treatment implemented standardized CRS+HIPEC. Otherwise you maybe come to the opposite conclusion that CRS+HIPEC were not the treatment of choice [22]. This article provided new ideas and methods for the treatment of a large number of BC PC patients.\u003c/p\u003e\n\u003cp\u003eThe disadvantage of this study was that the number of patients was too small to perform statistical analysis. The follow up time was short. Therefore, these findings in this study required more confirmations from large sample of evidence.\u003c/p\u003e"},{"header":"Conclusions ","content":"\u003cp\u003eThis paper reported 4 typical cases of BC PC successfully treated by a radical comprehensive treatments with CRS + HIPEC. These patients kept in good condition till now, with 32 months of mean overall survival since CRS+HIPEC. The 4 cases provided evidence that integrated therapy with CRS+HIPEC may be a promising strategy to improve outcome for BC PC patients.\u003c/p\u003e"},{"header":"List Of Abbreviations","content":"\u003ctable border=\"1\" width=\"0\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"130\"\u003e\n\u003cp\u003eAbbreviations\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"369\"\u003e\n\u003cp\u003eFull name\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"130\"\u003e\n\u003cp\u003eBC\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"369\"\u003e\n\u003cp\u003eBreast cancer\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"130\"\u003e\n\u003cp\u003eCRS\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"369\"\u003e\n\u003cp\u003eCytoreductive surgery\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"130\"\u003e\n\u003cp\u003eHIPEC\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"369\"\u003e\n\u003cp\u003eHyperthermic intraperitoneal chemotherapy\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"130\"\u003e\n\u003cp\u003ePC\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"369\"\u003e\n\u003cp\u003ePeritoneal carcinomatosis\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"130\"\u003e\n\u003cp\u003eBC PC\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"369\"\u003e\n\u003cp\u003eBreast cancer peritoneal carcinomatosis\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"130\"\u003e\n\u003cp\u003eSAEs\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"369\"\u003e\n\u003cp\u003eSerious adverse events\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"130\"\u003e\n\u003cp\u003eIDC\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"369\"\u003e\n\u003cp\u003eInvasive ductal carcinoma\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"130\"\u003e\n\u003cp\u003eILC\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"369\"\u003e\n\u003cp\u003eInvasive lobular carcinoma\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"130\"\u003e\n\u003cp\u003eGI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"369\"\u003e\n\u003cp\u003eGastrointestinal\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"130\"\u003e\n\u003cp\u003eKPS\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"369\"\u003e\n\u003cp\u003eKarnofsky performance status\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"130\"\u003e\n\u003cp\u003eULN\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"369\"\u003e\n\u003cp\u003eUpper limit of normal\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"130\"\u003e\n\u003cp\u003ePCI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"369\"\u003e\n\u003cp\u003ePeritoneal cancer index\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"130\"\u003e\n\u003cp\u003eCC\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"369\"\u003e\n\u003cp\u003eCompleteness of cytoreduction\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"130\"\u003e\n\u003cp\u003eOS\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"369\"\u003e\n\u003cp\u003eOverall survival\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"130\"\u003e\n\u003cp\u003eER\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"369\"\u003e\n\u003cp\u003eEstrogen receptor\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"130\"\u003e\n\u003cp\u003ePR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"369\"\u003e\n\u003cp\u003eProgesterone receptor\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"130\"\u003e\n\u003cp\u003eHER-2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"369\"\u003e\n\u003cp\u003eHuman epidermal growth factor receptor 2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003eConsent for publication\u003c/h2\u003e\n\u003cp\u003eWritten informed consent was obtained from the 4 patients for publication of this article and accompanying images. A copy of these written consent is available for review by the Editor-in-Chief of this journal.\u003c/p\u003e\n\u003ch2\u003eAvailability of data and material\u003c/h2\u003e\n\u003cp\u003eThe datasets used and analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003ch2\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThis work was supported by the Beijing Municipal Administration of Hospital Ascent Plan (DFL20180701); Beijing Municipal Grant for Medical Talents Group on Peritoneal Surface Oncology (2017400003235J007) (both to Yan Li).\u003c/p\u003e\n\u003ch2\u003eAuthors' contributions\u003c/h2\u003e\n\u003cp\u003eJun-hui Yu organized the patient's medical records and was the major contributor in writing the manuscript.\u003c/p\u003e\n\u003cp\u003eYu Feng, Xin-bao Li and Yan-Ping Li collected the patient's medical records.\u003c/p\u003e\n\u003cp\u003eCheng-Yan Zhang and Feng Shi collected the patient's pathological pictures.\u003c/p\u003e\n\u003cp\u003eSong-Lin An, Gang Liu, Yan-Bin Zhang, Kai Zhang, Zhong-He Ji, Bing Li and Guo-Jun Yan conducted the procedures of CRS + HIPEC.\u003c/p\u003e\n\u003cp\u003eYan Li designed the project, monitored project progress, and contributed to data evaluation of the manuscript.\u003c/p\u003e\n\u003ch2\u003eAcknowledgement\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eChen W, Zheng R, Baade PD, Zhang S, Zeng H, Bray F, Jemal A, Yu XQ, He J. 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Cureus. 2019; 11(8): e5367.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Breast cancer, Peritoneal carcinomatosis, Cytoreductive surgery, Hyperthermic intraperitoneal chemotherapy","lastPublishedDoi":"10.21203/rs.3.rs-31253/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-31253/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Breast cancer (BC) has been ranked as the first malignancy most common and the fifth in mortality rate among women in China [1]. Peritoneal metastases from BC is a rare disease and no guideline or international consensus for it. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e To summarize our experiences in cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) to treat breast cancer peritoneal carcinomatosis (BC PC). \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e This is a retrospective study on the 4 BC PC patients underwent CRS+HIPEC at our center. The clinicopathological features and treatment details on the BC PC patients were analyzed. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResult:\u003c/strong\u003e The average age at CRS+HIPEC was 59.8 years. The average duration of CRS+HIPEC was 8.8 h. The median number of resected organ areas was 7. Overall survival from CRS+HIPEC were 31, 28, 16 and 52 months. There were no serious adverse events (SAEs) during perioperative period. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e The 4 cases provided evidence that integrated therapy with CRS+HIPEC may be a promising strategy to improve outcome for BC PC patients. \u003c/p\u003e","manuscriptTitle":"Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Metastasis from Breast Cancer: A Preliminary Report on 4 Cases","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2020-05-29 18:44:31","doi":"10.21203/rs.3.rs-31253/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5e48b04a-3602-47cb-b0ea-90f55a28e65f","owner":[],"postedDate":"May 29th, 2020","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":109675,"name":"Cancer Biology"},{"id":109676,"name":"Oncology"}],"tags":[],"updatedAt":"2021-07-27T21:02:30+00:00","versionOfRecord":{"articleIdentity":"rs-31253","link":"https://doi.org/10.21037/gs-20-893","journal":{"identity":"gland-surgery","isVorOnly":true,"title":"Gland Surgery"},"publishedOn":"2021-04-01 21:02:30","publishedOnDateReadable":"April 1st, 2021"},"versionCreatedAt":"2020-05-29 18:44:31","video":"","vorDoi":"10.21037/gs-20-893","vorDoiUrl":"https://doi.org/10.21037/gs-20-893","workflowStages":[]},"version":"v1","identity":"rs-31253","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-31253","identity":"rs-31253","version":["v1"]},"buildId":"GqpaHPwrfC8PjnIFayRh5","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}