Peritoneal Carcinomatosis

Peritoneal carcinomatosis is a frequent sign of therapeutic failure in patients suffering from digestive and gynaecological cancer, and is often the form of appearance. Despite curative surgery, 20-30% of patients will develop a local recurrence. It has been classically considered as a sign of generalised disease and a therapeutic challenge, treated in a palliative way with an inevitably fatal outcome.

Sugarbaker

‘Sugarbaker’ technique doubles survival in colon cancer

The approach to cancer in a personalised medicine which focuses on the patient with a multidisciplinary approach, with treatments such as hyperthermic intraperitoneal chemotherapy (HIPEC), also known as the Sugarbakertechnique increases survival of patients with neoplasms spread into the abdominal cavity.

The technique developed by Dr. Paul H. Sugarbaker in 1982 considers the removal of the entire visible tumour and, subsequently, the perfusion of HIPEC (at 43^o C) in the abdominal cavity to remove non-visible malignant cells, as heat enhances the effect of chemotherapy. This technique achieves survival outcome not recorded with any of the established treatments, reaching a rate of 50% in colon cancer at 5 years.

Treatment with HIPEC allows combining a high intensity of chemotherapy doses, focused on the affected area, with a lower systemic toxicity due to the limitation in the passage of the drug from the peritoneal cavity to the systemic torrent due to the characteristics of the peritoneal membrane and the drug itself. Its use requires highly qualified facilities with multidisciplinary teams and a degree of specialisation in oncological surgery as it is a very complex technique.

Equipo Médico

Antonio Brugarolas Masllorens
Head - Oncology Department
Quirónsalud Torrevieja Hospital
Partida de la Loma s/n. 03184 Torrevieja (Alicante)
Quirónsalud Alicante
Calle Cruz de Piedra, 4. 03015 Alicante
Experience
Dr. Brugarolas was head of the Department of Oncology and served as Associate Professor of Oncology at the University of Navarra between 1980 and 2000, developing a multidisciplinary, care and teaching programme where more than 30 specialists have been trained. He has supervised over 20 doctoral theses and is the author or co-author of more than 100 publications or chapters in books on his speciality.

Since September 2000 he has developed and steered the Oncology Platform of Quirónsalud Torrevieja Hospital, an innovative project that brings together numerous qualified professionals from different specialities to provide comprehensive cancer care with top-level results and quality, currently a national benchmark in cancer treatment.
Techniques
Special programmes:

Personalised therapy based on the Molecular Profile of the tumour.

Intra-arterial Chemotherapy: supra-selective of supra-aortic trunks, liver, limbs.

Immunotherapy: High doses of Interleukin-2, TIL cell vaccines, dendritic cell vaccines.

High doses of Chemotherapy and Autologous Bone Marrow Transplant.

Intraoperative perfusion of Chemotherapy with hyperthermia (HIPEC) in pleura and peritoneum. (Sugarbaker).

Treatments:

Abdominal and Chest Cancer Surgery.

Sarcoma Surgery.

Oncoplasty and Reconstructive Surgery.

Intraoperative Perfusion of Organs and Tissues.

Breast Unit.

Electrochemotherapy.

Training

He specialised in oncology in the US, as an intern in the first year in pathology at the Metropolitan Hospital.

1984 Doctor of Medicine from the University of Navarra.

1968 ECMFG Certification.

1967, Intern through open competition at the Hospital Clinic.

1967 Bachelor of Medicine from the University of Barcelona.

Recognition and publications

Publication of over two hundred articles in international scientific journals.

See file
José Farré Alegre
General and Digestive System Surgery Department Specialist
Quirónsalud Torrevieja Hospital
Partida de la Loma s/n. 03184 Torrevieja (Alicante)
Quirónsalud Alicante
Calle Cruz de Piedra, 4. 03015 Alicante
Experience
Dr. José Farré has more than forty years of experience working at the top level in the General and the Digestive System Surgery speciality, where his high degree of specialisation cancer surgery stands out. He has been carrying out this work in coordination with the Oncological Platform of Quirónsalud Torrevieja since 2001.
Techniques

Peritoneal or pleural carcinomatosis surgery with Chemotherapy in hyperthermia (HIPEC), based on Sugarbaker Technique.

Liver surgery. Ablation of tumours with radiofrequency.

Perfusion of limbs with TNF and Melphalan in the treatment of Melanomas in transitory Sarcomas of limbs.

Electrochemotherapy for the treatment of non-operable skin tumours.

Intraoperative radiotherapy for the treatment of breast cancer, retroperitoneal, rectum, pancreatic, gastric tumours, etc.

‘ONE STEP' therapy in early breast cancer.

Training
Certificate of Off-Site Training as a Console Surgeon using the da Vinci Surgical System. April 2009

Title of Specialist in Digestive System Surgery (1982)

Title of Specialist in General Surgery (1980)

Resident of the Surgery Department at the Hospital de la Mutua of Terrassa.

Bachelor of Medicine and Surgery from the University of Barcelona (1976)
Recognition and publications
Author of several publications in international scientific journals of his speciality
See file
Manuel Sureda González
Oncology Department Specialist
Quirónsalud Torrevieja Hospital
Partida de la Loma s/n. 03184 Torrevieja (Alicante)
Experience
He began his professional career at the General Hospital of Catalonia in 1991. In 1993, he was appointed Head of the Medical Oncology Department of that hospital, a position he held until 2000, when he was appointed Director of the Cancer Institute. Between 1993 and 2002 he was responsible for the hematopoietic progenitor transplant programme of the hospital, accredited by the Regional Department of Health under the Regional Government of Catalonia. He is currently working at the Oncology Platform of the Quirónsalud Hospital in Torrevieja.
Techniques
Special programmes:

Personalised therapy based on the Molecular Profile of the tumour.

Intra-arterial Chemotherapy: supra-selective of supra-aortic trunks, liver, limbs.

Immunotherapy: High doses of Interleukin-2, TIL cell vaccines, dendritic cell vaccines.

High doses of Chemotherapy and Autologous Bone Marrow Transplant.

Intraoperative perfusion of Chemotherapy with hyperthermia (HIPEC) in pleura and peritoneum. (Sugarbaker).

Treatments:

Abdominal and Chest Cancer Surgery.

Sarcoma Surgery.

Oncoplasty and Reconstructive Surgery.

Intraoperative Perfusion of Organs and Tissues.

Breast Unit.

Electrochemotherapy.

Training

Specialisation in Medical Oncology at the Navarra University Clinic between 1986 and 1989, Training at the Immunotherapy Laboratory of the Department of Oncology of the Cleveland Clinic Foundation (Cleveland, Ohio, USA).

Doctor of Medicine from the University of Navarra with the cum laude distinction (1991).

He studied Medicine at the University of Navarra (1979-1985) obtaining the Outstanding distinction in the Degree.

Recognition and publications
He is the author of more than 50 papers at congresses and articles in specialised journals.

He is a member of international societies of his domain specialisation (AACR, ASCO, ASH).
See file
Pedro Bretcha Boix
Head of the General and Digestive System Surgery/ Surgical Oncology Department
Quirónsalud Torrevieja Hospital
Partida de la Loma s/n. 03184 Torrevieja (Alicante)
Quirónsalud Alicante
Calle Cruz de Piedra, 4. 03015 Alicante
Experience
Dr. Pedro Bretcha has been practicing his profession for twenty years at Quirónsalud Torrevieja Hospital as a founding member of the Oncology Platform in a multidisciplinary team implanting multiple cancer techniques. Pioneer in many avant-garde techniques for cancer treatment, he performed the first Isolated Perfusion of Liver with Melphalan and Hyperthermia in Spain, as well as the treatment of peritoneal carcinomatosis via cytoreductive surgery + perioperative intraperitoneal chemo-hyperthermia (HIPEC), intraoperative radiotherapy, oncological rescue surgery of the liver, pancreas, pelvis, etc.
Techniques

Peritoneal or pleural carcinomatosis surgery with Chemotherapy in hyperthermia (HIPEC), based on Sugarbaker Technique.

Liver surgery. Ablation of tumours with radiofrequency.

Perfusion of limbs with TNF and Melphalan in the treatment of Melanomas in transitory Sarcomas of limbs.

Electrochemotherapy for the treatment of non-operable skin tumours.

Intraoperative radiotherapy for the treatment of breast cancer, retroperitoneal, rectum, pancreatic, gastric tumours, etc.

‘ONE STEP' therapy in early breast cancer.

Training
Certificate of Off-Site Training as a Console Surgeon using the da Vinci Surgical System. April 2009.
He obtained the Diploma of Cancer Surgery from the European Board of Surgery (EBS) on 29 November 2006.
Hepato-biliary and Pancreatic Surgery at the Hospital Mútua of Tarrasa from January 2000 to February 2001. He got his M.I.R. position in 1994 and did his residency in General and Digestive System Surgery at the Hospital Mutua of Tarrasa from January 1995 to December 1999.
1995-96-97: Doctorate courses, meeting the research requirements from the Autonomous University of Barcelona:
1986 - 1993: Bachelors in Medicine and Surgery from the Autonomous University of Barcelona at the Teaching unit of the Valle de Hebrón Hospital.
Recognition and publications

Vice-president of the Spanish Society of Surgical Oncology (SEOQ)

Active member of the European Society of Surgical Oncology (ESSO)

See file
Rosa María Cañón Rodríguez
Head of Radiation Oncology Department
Quirónsalud Torrevieja Hospital
Partida de la Loma s/n. 03184 Torrevieja (Alicante)
Experience
Dr. Cañón has in-depth clinical experience in the treatment of cancer patients. She is a national reference for treatments such as chemotherapy and autologous bone marrow transplant and management of chemotherapy and radiotherapy toxicity, as well as radiosurgery and radiotherapy.
Techniques

Conventional and Three-dimensional Conformal Radiotherapy.

Simulation and Planning with image fusion: CAT-CAT, CAT-MRN, CAT-PET.

Intensity Modulated Radiation Therapy: IMRT (Steep and shoot and sliding window Simulation).

Radiosurgery.

Fractionated stereotactic radiotherapy: cranial.

Fractionated stereotactic radiotherapy: extra-cranial: pulmonary, hepatic, bone.

Image-guided Radiation Therapy: IGRT, with fiducial implants for daily checking and correction of positioning.

High-rate dosage brachytherapy: endocavitary: Gynaecological, Bronchial.

High-rate dosage brachytherapy: interstitial: Prostate, Cutaneous.

Intraoperative radiotherapy: overprinting dose (digestive system tumours, lung tumours, sarcomas) and single dose (breast cancer).

Photodynamic Therapy: interdisciplinary therapeutic modality which uses laser light irradiation as an energy source on tumours on which photosensitising agents have been administered. It can be used as a single modality or in combination with surgery, ionizing radiation or others.

Singular projects in Radiotherapy:

1. IMRT (prostate, pelvic tumours, head and neck, Re-irradiation).
2. IGRT: Radiotherapy guided by fiducial implants (Acculoc).
3. Cerebral stereotactic radiotherapy.
4. Extra-cranial stereotactic radiotherapy.
5. Intraoperative Radiotherapy: IOR in breast cancer.
6. Brachytherapy: Prostate BR.

1- Intensity Modulated Radiation Therapy (IMRT): enables the treatment to be modulated taking into account the patient's internal anatomy. Useful for shortening treatments (hypofractionation), increasing doses or protecting organs:

Brain: Re-irradiation.

O.R.L. Tumours.

Chest.

Abdomen: Digestive tumours and retroperitoneal sarcomas.

Pelvis: Prostate cancer, rectum cancer and gynaecological tumours.

2- Guided radiotherapy/IMRT with fiducial implants: Enables daily on-line checking and correction prior to each radiotherapy session, administering the treatment with maximum precision. Pioneer in this technique.
Open programme in:

Prostate carcinoma (dose escalation and reduction of treatment days).

Training
Bachelor of Medicine and Surgery from the University of Madrid (1991), she underwent her MIR specialisation at the University Clinic of Navarra.
Recognition and publications

Publication of an article in an international scientific journal

See file
Andrés Poveda
Oncologist
Quirónsalud Valencia Hospital
Av. De Blasco Ibañez,14. 46010 Valencia
Experience
Dr. Poveda has been working for more than thirty years at the Valencian Institute of Oncology, where he was head of the section until 2017. Coordinator along with Dr. López Martos, from the oncology department at the Quirónsalud Valencia Hospital.
Techniques
His clinical and research work is particularly focused on gynaecological tumours and sarcomas. His areas of expertise are ovarian cancer, endometrial cancer, cervical cancer and other gynaecological tumours, as well as soft tissue sarcomas and GIST.

Dr. Andrés Poveda is actively involved in clinical trials with special participation in gynecology and sarcoma tumour fields. He regularly works with several national and international cooperative research groups (Geico, Geis, STSB-EORTC, GCIG groups...) and is the lead investigator of several research protocols.
Training
Bachelor of Medicine from the University of Valencia in 1977.

Medical Oncology Specialist since 1982.
Recognition and publications
Founding member and until 2013, President of the Spanish Ovarian Cancer Research Group (GEICO). Founding member of the Spanish Sarcoma Research Group (GEIS); he is in the Executive Committee of both the groups.

He is a member of the steering committee of the GCIG (Gynecologic Cancer InterGroup) and is currently its Executive Chairman.

He has actively participated in the global consensus on Ovarian Cancer of 2004, 2010 and 2015, and is the co-author of its publications.

Professor of medical oncology in several postgraduate courses, medical consultant in different scientific events. He has developed and established the ‘International Symposium on Advanced Ovarian Cancer: Optimal Therapy', a forum that brings together the world's leading experts in this speciality, which has been held in Valencia biannually since October 1996; and has been the co-president since then. His works are published entirely in the International Journal of Gynaecological Cancer, Annals of Oncology and Cancer.

He is a member of the editorial board of several scientific journals and author of more than 80 publications, especially in the areas of gynaecological tumours and sarcomas.

He is an active member of the American Society of Clinical Oncology (ASCO) and the European Society of Medical Oncology (ESMO). He is a member (he was its president between 2010 and 2014) of the group of professors of gynaecological cancer of this society (ESMO). At ESMO 2014 symposium, he was chairman of the scientific committee on gynaecological cancer. He is scientific advisor of the ESMO-ASIA 2018 congress (Singapore, November 2018).
See file
Blas Flor Loriente
Head of the General and Digestive System Surgery/ Surgical Oncology Department
Quirónsalud Valencia Hospital
Av. De Blasco Ibañez,14. 46010 Valencia
Experience
Head of the General and Digestive System Surgery Department at the Quirónsalud Valencia Hospital and a colorectal cancer surgery specialist, he has more than fifteen years of experience in cancer surgery. The physician has performed more than 1,000 colon and rectal cancer operations with less than 5% local recurrence rates.

Specialist in General and Digestive System Surgery Department. Coloproctology Unit. University and Polytechnic La Fe Hospital Valencia
Techniques
Oncological Surgery

Colon Cancer Surgery

Pelvic Exenteration
Training

ANECA - National Accreditation as University Assistant Professor (2017)

AVAP – Accreditation as University Professor (2013)

Doctoral thesis "Predictive factors of recurrence and survival in rectal cancer after TME surgery" Distinction "cum laude" (02-12-05)

European Board of Coloproctology EBSQ-c (Prague 2009)

Extraordinary Prize for his Degree in 1996 (with 15 Distinctions) Faculty of Medicine, Valencia

Recognition and publications

Over 50 publications indexed in PubMed

Participated in more than 100 Congresses through invitation

Presented over 30 papers at International Congresses

10 Book Chapters

4 Doctoral Theses supervised

4 Participations in Funded and Competitive Research Projects (AEC GRANTS, AECP GRANTS, FIS GRANTS)

National Coloproctology Award from AECP (Spanish Coloproctology Association) 2 times.

See file
Francisco Ripoll Orts
Breast Diseases Surgeon
Quirónsalud Valencia Hospital
Av. De Blasco Ibañez,14. 46010 Valencia
Experience
Dr. Ripoll has in-depth experience in the field of breast surgery, and he has been the head of hospitals of reference such as University and Polytechnic La Fe Hospital of Valencia. Since 2017, this renowned surgeon heads the breast surgery and diseases department at the Quirónsalud Valencia hospital, applying advanced cancer surgery techniques with a high cure percentage through minimally invasive and conservative surgeries.

The physician also combines his medical activity with university teaching at the University of Medicine since 2011.
Techniques

Prevention of breast diseases.

Early diagnosis of cancer.

Diagnosis and treatment of benign breast diseases.

Multidisciplinary treatment of breast cancer.

Post-mastectomy reconstruction.

Intraoperative Radiotherapy.

Training

Master in Healthcare Management from the Catholic University of Valencia, from October 2014 to June 2015.

Master in Senology and Breast Diseases from the University of Barcelona (2010-2012).

Training programme at the Breast Diseases Unit of the ISTITUTO EUROPEO DI ONCOLGIA in Milan, with Professor Umberto Veronessi.

Doctor in Medicine and Surgery from the University of Valencia in 1996.

Bachelor of Medicine and Surgery from the University of Valencia in 1988.

Recognition and publications

National Surgery Award 1998. For the work: "Genetic alterations and oxidative metabolism in sporadic colorectal tumours from a Spanish community." Published in: Mol. Carcinogénesis, 1997.

Authored over 50 Papers at Spanish Congresses and more than 20 papers at International Congresses in his speciality. He has also published more than 30 articles, including 7 in international journals, and two book chapters.

Organiser, coordinator and teacher of the Training Courses in Breast Diseases for intern doctors of General and Digestive System Surgery and Surgical Specialists, organised by the Breast Diseases section of the Spanish Association of Surgeons, from 2013 till now.

See file
Juan José Monserrat Monfort
Urology Surgery Specialist
Quirónsalud Valencia Hospital
Av. De Blasco Ibañez,14. 46010 Valencia
Experience
Dr. Monserrat has more than thirty years of in-depth experience working as a specialist at hospitals such as the Doctor Peset Hospital and University Hospital La Fe in Valencia, where he has performed thousands of cancer surgeries via laparoscopy with high success rates, as well as in the application of innovative techniques for the treatment of Benign Prostatic Hyperplasia.
Techniques

Laparoscopic Surgery and Urological Cancer Surgery: prostate cancer, kidney and upper urinary tract cancer, bladder, penis, testicle and retroperitoneum cancer.

Benign Prostatic Hyperplasia Surgery, transurethral bipolar resection, green laser and Rezum (steam therapy).

Minimally invasive urologic surgery

Training

Urology Specialist through the MIR programme. University and Polytechnic La Fe Hospital 1993-1997

Master in Neurology and Urodynamics. 1995-1996. Surgery Department. University of Valencia.

Bachelor of Medicine and Surgery. University of Valencia. 1991.

Recognition and publications

Author of several scientific publications and member of the Spanish Association of Urology and European Association of Urology.

See file
Manuel Bernal Sprekelsen
ENT specialist in Endoscopic Surgery
Quirónsalud Valencia Hospital
Av. De Blasco Ibañez,14. 46010 Valencia
Experience
Doctor Manuel Bernal Sprekelsen, professor of otolaryngology at the Medical University of Valencia, has spent most of his professional career as the head of department at Hospital Clínic of Barcelona. Recently he has joined the medical panel of Quirónsalud Valencia Hospital to provide his services with the aim of offering its patients minimally invasive endoscopic techniques for treating diseases of the nose and sinuses of which he is one among the most pioneering doctors world-wide. Likewise, Dr. Manuel Bernal is one of the renowned benchmarks for the treatment of laryngeal cancer using transoral microsurgery with carbon laser which combines the accuracy and clotting ability of carbon laser with the microscopic control and provides very good oncological and functional results. Currently opted as the first-choice treatment for early laryngeal cancer as it offers more than 90% survival rate at 5 years, as well as the preservation of larynx.
Techniques

Endoscopic surgery of paranasal sinuses and skull base

Reconstructive surgery of the middle ear.

Minimally invasive surgery of laryngeal and hypopharyngeal tumours.

Training
Associate professor of Otolaryngology, Head and Neck (1997), Ruhr-Univ.Bochum, Germany

Postdoctoral studies: Plastic and Reconstructive Surgery (1991), St. Elisabeth Hospital, Ruhr-Univ.Bochum, Germany

Speciality: Otorhinolaryngology- Head and neck (1987). University of Mainz, Germany

Doctorate degree: 1982 Johannes-Gutemberg University of Mainz (Germany)
Recognition and publications

Author of more than 170 articles indexed in journals and 15 books of his speciality.

Vice-president of the Spanish Otorhinolaryngology Society.

See file
Joseba Rebollo
Oncology
Quirónsalud Alicante
Calle Cruz de Piedra, 4
Experience
Since 1991, Doctor Rebollo has worked as an oncologist at several hospitals and medical centres. He has been Service Head for the Department of Oncology at Clínica San Miguel in Navarre and at Hospital General in Villalba. He has been part of the Oncology Platform at Hospital Quirónsalud Torrevieja, and is currently an Oncologist at Quirónsalud Alicante.
Techniques
Specialist in Medical Oncology.
Training
He graduated with honours in Medicine and Surgery at the University of Navarre in 1985. Later, he completed his residence in Medical Oncology at the University of Navarre Clinic. In 1987, he completed the XX Educational Commission for Foreign Medical Graduates (ECFMG). Doctor Rebollo trains continuously, taking complementary courses on Metastatic Breast Cancer or Multi-Centric Colo-Rectal Cancer.
Recognition and publications
Doctor Rebollo is a member of the Fundación Grupo Español de Investigación en Cáncer de Mama [Spanish Breast Cancer Research Group Foundation]. He has written many publications at the national and international levels.
See file
Carlos Fernandez-Martos
Medical Oncology
Hospital Quironsalud Valencia.
Severo Ochoa, 14 bajo. 46010 Valencia
Experience
Head of Gastrointestinal Oncology Department. 2017-present

Head of Gastrointestinal Oncology Unit, Department of Medical Oncology, Fundacion Instituto Valenciano de Oncologia. 2002-present

Assistant General Manager, Fundacion Instituto Valenciano de Oncolgia. 1998-2002

Clinical Assistant Medical Oncologist: 1984-1998. Fundación Instituto Valenciano de Oncologia

1981: Fellow MD Anderson Houston, USA
Techniques
He is leading several academic prospective clinical trials that aim at developing new strategies, therapies and biomatkers for colorectal cancer treatment.

His chief areas of clinical activity and research are in the management of gastrointestinal malignancies
Training
MD, Facultad de Medicina, Universidad Complutense de Madrid, 1973-1976

MD, Facultad de Medicina, Universidad de Valencia, 1976-1979

BS, Facultad de Medicina, Universidad de Granada, 1980
Recognition and publications
He is the author or co-author of more than 50 peer-reviewed publications.

He is currently member of the Rectal-Anal Task-Force group of the National Cancer Institute, USA

He is founder and current president of the Spanish Multidisciplinary Group of Digestive Cancer (GEMCAD) and active member ofv the Amercican Society of Medical Oncology (ASCO)

Evaluator of scientific projects including Cancer Research UK and Institute National du Cancer, France
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