Peritoneal carcinomatosis of colorectal origin. Current treatment: Review and update

Abstract

Colorectal cancer is the most frequent tumor of the digestive tract. The high incidence of abdominal dissemination; the poor prognosis of these patients, with median survival consistently ranging from 5 to 9 months in all studies of peritoneal carcinomatosis from colorectal cancer; the failure of adjuvant systemic chemotherapy treatment with a maximal survival of 18 months despite the development of new cytostatic drugs, and new combinations of use, make it crucial to search for and develop new treatment strategies. We review the principles of Sugarbaker´s treatment protocol, which involves the combination of maximum cytoreductive radical oncological surgery for the treatment of all macroscopically disseminated disease with maximum perioperative intraperitoneal intensification chemotherapy to treat residual microscopic disease. We present the results of several scientific papers, all of them phase II studies with more than 10 patients treated, published in the medical literature by the main groups working in this line of treatment, together with the only phase III study reported and published so far, and finally the results of a recently reported retrospective international multicenter study. With this new alternative therapeutic approach, overall mean survival is 40% at 36 months, and 20% at 5 years. Based on these results, this new therapeutic approach is proposed as the treatment of choice for these unfortunate patients.

Update on Colorectal Carcinomatosis—From Molecular Biology to Diagnosis and Management

“…Occasionally, patients needed a surgical intervenetion for intestinal occlusion, haemorrhage, or perforation caused by CP but most realized laparotomies for taking biopsies and then being referred to their oncologists for treatment with systemic chemotherapy [2]. Nowadays, with the introduction of locoregional therapies, promising results are suggested by several centers, namely cytoreductive surgery (CRS) combined with intraoperative intraperitoneal chemotherapy (PIC) without/with hyperthermia [1,3].…”

“…It is estimated that, at the time of diagnosis, the peritoneal surface is already involved in 10% -15% of cases [2], and that, after CRC curative surgical resection, PC occurs in up to 50% of patients [2,3]: 4% -19% during follow-up time and in almost 44% of the patients who require relaparotomy [4]. In 25% of patients, CRC recurrence is confined to the peritoneal cavity [2,4].…”

“…In Colorectal Cancer (CRC), the precise incidence of PC is not known, as the majority of the CRC follow-up studies cannot detect the disease in its initial stages [2]. It is estimated that, at the time of diagnosis, the peritoneal surface is already involved in 10% -15% of cases [2], and that, after CRC curative surgical resection, PC occurs in up to 50% of patients [2,3]: 4% -19% during follow-up time and in almost 44% of the patients who require relaparotomy [4].…”

“…Natural history studies show that Colorectal cancer PC is considered a terminal disease, with an median survival of 6 -8 months [3,5], so treatment of this disseminated condition represents one of the Oncology limits [2,5]. Occasionally, patients needed a surgical intervenetion for intestinal occlusion, haemorrhage, or perforation caused by CP but most realized laparotomies for taking biopsies and then being referred to their oncologists for treatment with systemic chemotherapy [2].…”

“…Peritoneal carcinomatosis (PC) consisted in the implantation of tumour cells throughout the peritoneal cavity [1] and, until recently, has been associated with a poor prognosis and considered a almost untreatable condition [1,2].…”