Effective Strategies to Predict Survival of Colorectal Peritoneal Metastases Patients Eligible for Cytoreductive Surgery and HIPEC

Abstract

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), often combined with systemic therapy, can be offered to selected colorectal peritoneal metastases (PM) patients. However, clinical heterogeneity and the lack of high-level evidence challenges determination of the correct treatment strategy. This review aims to provide an overview of current strategies to predict survival of colorectal PM patients treated with CRS and HIPEC, guiding clinicians to select a suitable treatment-strategy and to inform patients about their prognosis. First, the prognostic relevance of several clinicopathological prognostic factors, such as extent of PM, location of primary tumor, histology type, and the presence of lymph node or liver metastases will be discussed. Subsequently, special attention will be given to recent developments in several aspects of tumor biology such as RAF/RAS mutations, circulating tumor DNA, immunoprofiling, and consensus molecular subtypes. Finally, currently available prognostic models to predict survival will be evaluated, concluding these models perform moderate to good, but most of them partly rely on intra-operative data. New insights in tumor biology, as well as the reliable assessment of extent of peritoneal disease by diffusion weighted MRI pose promising opportunities to establish an adequate and clinically meaningful preoperative prognostic model in the near future.

Simultaneous Approach of Colo-Rectal and Hepatic Lesions in Colo-Rectal Cancers With Liver Metastasis – A Single Oncological Center Overview

“…By forcing the attitude, studies could be performed in the future to apply HIPEC directly, only in the presence of the tumor in the T4 stage. In this regard, recent studies by Geert A. Simkens et al [26], N. B. Arrizabalaga et al [27], D. Cortes-Guiral et al [28] indicates that the treatment of carcinomatosis in patients with liver metastases is still controversial, without significant improvement in survival, but may be applied to carefully selected patients in clinical trials.…”

Current Trends in Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for Peritoneal Disease from Appendiceal and Colorectal Malignancies

“…However, similar to circulating tumor markers, circulating ctDNA levels do not consistently correlate with peritoneal tumor burden [ 71 , 72 , 73 ]. Comparably, immunoprofiling has been proposed for pre- and post-operative disease detection and potential therapeutic selection with promising results [ 74 , 75 , 76 ]. Prospective studies evaluating the prognostic implications of using ctDNA, new tumor markers, and immunoprofiling before and after intraperitoneal chemotherapy methods are underway (NCT04122885, NCT04083547).…”

Predictive Genetic Biomarkers for the Development of Peritoneal Metastases in Colorectal Cancer

“…Metastatic colorectal cancer (CRC) is a common cause of cancer-related mortality. At initial diagnoses, almost one-fourth of CRC patients present with metastases [ 1 , 2 ]. Liver metastases (LMs) occur most frequently, followed by peritoneal metastases (PMs) [ 2 , 3 ].…”

“…At initial diagnoses, almost one-fourth of CRC patients present with metastases [ 1 , 2 ]. Liver metastases (LMs) occur most frequently, followed by peritoneal metastases (PMs) [ 2 , 3 ]. PMs are characterized by the development of solid tumor deposits on the peritoneal surface [ 4 ].…”

“…It is suggested that PMs develop through the shedding of tumor cells from the primary tumor, leading to intraperitoneal seeding [ 1 ]. Synchronous PMs are found in approximately 5–15% of patients with colorectal cancer at primary surgery [ 2 , 3 , 4 , 5 ], but PM may also develop metachronously after curative-intent treatment of the primary tumor. In clinical studies, these metachronous PMs are reported in 4–12% of patients following curative resection for colon cancer and in 2–19% of patients following curative resection for rectal cancer [ 5 ].…”