First Graduates of the European School of Peritoneal Surface Oncology 24/01/2017
Peritoneal surface malignancies (PSM) are rare cancers encompassing several types of tumour with a wide range of prognostic spectrum, often at an advanced stage. They develop in the peritoneum, a thin layer of tissue (ephitelium) that lines the abdomen and covers important organs e.g. the bladder. The role of surgery in their multidisciplinary management is key, but it is even more important when applied in combination with the locoregional approach to PSM, consisting in the combination of cytoreductive surgery (CRS) and the intraperitoneal instillation of chemotherapies under hyper-thermic condition (HIPEC). This is an innovative approach for certain PSM cancers, which allows to obtain the macroscopic and microscopic cytoreduction of the peritoneal disseminated disease and, thus, greatly benefit the patient.
A joint venture between ESSO and the Peritoneal Surface Oncology Group International (PSOGI), the European School of Peritoneal Surface Oncology (ESPSO) has been established to provide both a basic and an advance training in peritoneal surface oncology. Under the supervision of a tutor from a PSOGI recognized centre, each student enrols in a peritoneal surface oncology treatment programme taking place in one of the participating ESPSO centres, such as the Gustave Roussy in Paris or the MD Anderson in Madrid (you can read the full list here). The educational programme includes participation in two ESSO Courses, the ‘ESSO Advanced Course on the Management of HIPEC after CRS’ and the ‘ESSO Course on Peritoneal Surface Malignancy’, as well as in at least one PSOGI World Congress and a recognised national peritoneal surface oncology congress. At the end of their studies, ESPSO participants submit a research project – which is then presented at one of these congresses and submitted for publication in a peer-reviewed journal (the project could even evolve into a thesis) – and successful students receive the European Certification on Peritoneal Surface Oncology, attesting the proficient knowledge of the scientific basis and the clinical management of these types of cancer.
At the ESSO 36 congress in Krakow we had the chance to meet with an expert in this field, Professor Marcello Deraco from the National Cancer Institute of Milan, Italy, and ask him a few questions (read the full interview of Prof. Deraco here). Deraco is the Director of this exclusive School – launched in 2014 from the initiative of the ESSO President Professor González Moreno, Professor Shiga Kusamuri and himself – and today included in the ESSO educational programme.
The idea behind the creation of this School is to provide a focused and structured training in the management of PSM. The School is directed to surgical oncologists or surgeons having completed a general surgery residency and a basic surgical oncology training, and/or involved in a ‘peritoneal surface oncology treatment programme’. As cytoreductive surgery and heated chemotherapy are very complex procedures to treat peritoneal neoplasms, they require high proficiency in several technical nuances that every surgical oncologist – even at the senior level – need to master. A well-structured tutored training programme like the ESPSO is therefore essential to have a complete understanding of this topic, and keep the pace with the advancement of the knowledge in this field.
Prof. Deraco explained us that these techniques were introduced in Europe for the first time in the early nineties. At that time, surgeons could only acquire some expertise on PSM on a self-learning basis, after having visited a well-established centre in the US where the HIPEC procedure was developed. Under these circumstances the learning process took a lot of time, and in more recent years the same training could only be obtained in a few centres founded by the pioneers of the technique in Europe. “With the ESPSO we are sure that the learning process will be shortened” says Deraco “and that the surgeon embracing this specialisation will have more consistent instruments to proceed on his own in his centre, after the completion of his training”.
Some of the participants who finished the School last November already shared their experience with us. “The European School of Peritoneal Surface Oncology training programme offered me the opportunity to attend national and international training courses and conferences and meet established teams from around the world. The training programme was well organised with excellent support from the administrative staff and faculty” says Dr. Simon Fallis from the Good Hope Hospital, Birmingham, United Kingdom. Andreas Larentzakis, from the National and Kapodistrian University of Athens, Greece, describes the School programme as “a meticulously structured training process that guided me through the challenging field of Peritoneal Surface Oncology and provided me with both the basic and the advanced knowledge on theoretical and practical matters”. He continues “the ESPSO programme is a great opportunity to meet, discuss and interact with pioneers and leaders of cytoreduction surgery around the world, while at the same time, you have a Mentor supporting your efforts into the next steps of a Peritoneal Surface Oncology career”. “This is the first formal training in peritoneal oncology in the world and the directors are really masters in the subject” concludes Pilar Adriana Torres Mesa, another graduated ESPSO student from Bogotà, Colombia.
When asked about the state of advancement of research in this area, Deraco explains that researchers are currently exploring the molecular mechanisms of peritoneal progression of the tumours as well as the prognostic factors and potential druggable biological targets. These studies could further refine the therapeutic indications, but there is still a lot to investigate. Moreover, as CRS and HIPEC represent a considerable economic burden for the healthcare system and, at the same time, an unattractive area of investment for the main pharmaceutical industries, financial support for research is currently insufficient.
Despite these difficulties, the area of PSM management is attracting more and more interest in the medical sphere. Moreover, the word “multidisciplinarity” has a real meaning in this area, as people from both clinical and biological grounds usually intensely collaborate for many years to find better treatments for these malignancies. Several cutting-edge insights emerged from one of these intense collaborations – a research protocol on diffuse malignant peritoneal mesothelioma (DMPM), which involved for 5 years a large team of biologists and clinicians – and its results will improve the patients’ survival and quality of life.