A Letter from Kate’s Doctor, Dr. Paul Sugarbaker
A brief summary of the clinical and pharmacologic activities of Foundation for Applied Research in Gastrointestinal Oncology (FARGO) can be summarized as follows:
In science it is not unusual to see important progress in one medical condition have major implications for other diseases. This has been true for the success in the management of peritoneal metastases from appendiceal cancer. Peritoneal metastases from appendiceal neoplasms were 100% lethal in the past. Now, 70% of patients are free of disease at 10 years and probably cured. The strategies used for this remarkable success story are now being applied to colorectal cancer, gastric cancer, and pancreas cancer.
The treatment strategy used for appendiceal neoplasms is cytoreductive surgery (CRS) and hyperthermic perioperative chemotherapy (HIPEC). This combined treatment has become the standard of care for appendiceal cancer with peritoneal metastases. The cytoreductive surgery is used to remove all visible evidence of disease from the abdomen and pelvis. The perioperative chemotherapy is used to eradicate the microscopic residual disease.
In the absence of perioperative chemotherapy the most common site for gastric cancer to recur is at the resection site or nearby peritoneal surfaces. The same dismal statistic is true for pancreas cancer. For colorectal cancer local recurrence and peritoneal metastases are still a problem but less severe than with gastric cancer and pancreas cancer.
Because these other more common gastrointestinal cancers are invasive disease, success with CRS and HIPEC is most frequently seen when there is a limited extent of disease. Our current projects move the combined treatments to primary gastrointestinal cancer and in so doing markedly increase the proportion of patients cured of these devastating gastrointestinal malignancies.
Currently, all patients having surgery for gastrointestinal cancer have the same standardized surgical procedure. Then, those with a poor prognosis based on TNM staging are given systemic chemotherapy in a hope that it will rescue these patients from cancer death. Unfortunately, the adjuvant chemotherapy treatments are not effective in a cure although they sometimes increase the length of survival.
Our proposal is to identify those 20% of patients whose standard treatment of the primary cancer results in 80% of the poor outcomes. Through clinical, laboratory, endoscopic, and radiologic studies that have been well described, these 20% of patients would be identified and recommended by the multidisciplinary team for special treatments. Our goal would be to eliminate positive margins of resection, progressive disease within adjacent lymph nodes, and peritoneal metastases. Some of the possible special treatments for these “high risk” patients would be neoadjuvant chemotherapy, perioperative chemotherapy (HIPEC and EPIC), extended resections, and second-look surgery.
These efforts would, in my opinion, add greatly to the proportion of patients cured of gastrointestinal cancer rather than merely add to our current palliative efforts in patients who have recurrent disease.
Paul H. Sugarbaker, MD, FACS, FRCS
Medical Director, Center for Gastrointestinal Malignancies
Chief, Program in Peritoneal Surface Oncology
MedStar Washington Hospital Center
106 Irving St., NW, POB North Tower Suite 3900
Washington, DC 20010
Paul Sugarbaker is a top surgeon for peritoneal mesothelioma patients. He developed the Sugarbaker Procedure, a combination of cytoreductive surgery and heated chemotherapy.
Dr. Paul Sugarbaker is the director of the Center for Surgical Oncology at the Washington Cancer Institute, Washington Hospital Center, in Washington, D.C. where he is considered the leading surgeon treating patients with peritoneal mesothelioma.
As the son of a doctor, Dr. Sugarbaker was groomed to become one himself. In fact, he is the older brother of the leading surgeon for pleural mesothelioma patients, David Sugarbaker, M.D. Together, these brothers have pushed the limits of treating mesothelioma.
In the 1980s, Dr. Paul Sugarbaker fought to develop his signature treatment method, known now as the Sugarbaker Procedure. This surgical treatment faced controversy over, as some would argue, the radical method of applying heated chemotherapy drugs directly to the abdomen after surgically removing any visible tumors.
Although the procedure has its critics, this treatment has greatly extended the lives of countless patients.
Dr. Paul Sugarbaker’s Accomplishments:
- Developed the Sugarbaker Procedure, the leading treatment for peritoneal mesothelioma patients
- Founding member, International Society of Regional Cancer Therapy
- Founded the nonprofit Foundation for Applied Research in Gastrointestinal Oncology
- Award-winning surgeon for his service and research