Long-term results after proactive management for locoregional control in patients with colonic cancer at high risk of peritoneal metastases

Sammartino, Paolo; Sibio, Simone; Biacchi, Daniele; Cardi, Maurizio; Mingazzini, P; Rosati, Maria Sofia; Cornali, Tommaso; Sollazzo, Bianca Maria; Atta, Jabeen; Giorgio, Angelo Di

doi:10.1007/s00384-014-1929-4

Cited by 57 publications

(52 citation statements)

References 35 publications

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“…So authors concluded that CRS and HIPEC seems to be safe and beneficial in peritoneal metastases of colorectal origin[33]. But literature assessing benefit of HIPEC for SRCC is scarce and controversial with studies denying[34,35] and implying[36] benefit of HIPEC in this subgroup. But these reports are retrospective and are fraught with small sample sizes.…”

Section: Discussionmentioning

confidence: 99%

Signet ring colorectal carcinoma: Do we need to improve the treatment algorithm?

Tamhankar

Ingle

Bal

et al. 2016

WJGO

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AIMTo elaborate about this peculiar variant from a tertiary cancer center from India.METHODSIt’s a retrospective study (2011-2014) of all patients diagnosed with signet ring colo-rectal cancer (SRCC). Various clinico-pathological variables were studied.RESULTSOne hundred and seventy consecutive patients with SRCC were diagnosed (11.4% of all colorectal cancers). Median Age of the cohort was 41 years. Most common location was recto-sigmoid area (54.7%). Majority patients presented in stage III and IV (91.2%). Most of the stage IV patients had isolated peritoneal metastases (86.5%). Colonic tumors had higher incidence of peritoneal metastases (91.8% vs 83.3%) as well as isolated peritoneal recurrences (37.5% vs 16.7%) than rectal primaries. Thirty-seven point five percent of patients recurred after curative surgery. Amongst them 63.63% patients had isolated peritoneal recurrences. Circumferential resection margin (CRM) was involved in 17.9% patients. Median relapse free survival (RFS) and overall survival (OS) of the cohort were 14.9 and 18.13 mo respectively. CRM involvement, colonic primary were associated with poorer RFS and OS.CONCLUSIONSRCC has predilection for peritoneal dissemination. More aggressive and/or extended chemotherapy schedules as well as prophylactic hyperthermic intra-peritoneal chemotherapy at the time of primary surgery may be attempted in these patients.

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Section: Discussionmentioning

confidence: 99%

Signet ring colorectal carcinoma: Do we need to improve the treatment algorithm?

Tamhankar

Ingle

Bal

et al. 2016

WJGO

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“…In colorectal cancer, this has brought about a significant results (P < 0.03), related to control group (only surgery), in terms of PM developed and local recurrence (4% vs 28%, over a 48-mo follow-up period). Patients had also significant longer MS (59.2 mo vs 52 mo; P < 0.04) and disease free survival (P < 0.05) [105] . There was a hypothesis of secondlook surgery at 1 year in patients at high risk for PM, after the first radical surgery for colorectal cancer.…”

Section: Pm Multimodal Treatment -Research Pathways (2010-2014)mentioning

confidence: 90%

Multimodality treatment strategies have changed prognosis of peritoneal metastases

Lungoci

Mironiuc

Muntean

et al. 2016

WJGO

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For a long time, treatment of peritoneal metastases (PM) was mostly palliative and thus, this status was link with "terminal status/despair". The current multimodal treatment strategy, consisting of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), has been strenuously achieved over time, but seems to be the best treatment option for PM patients. As we reviewed the literature data, we could emphasize some milestones and also, controversies in the history of proposed multimodal treatment and thus, outline the philosophy of this approach, which seems to be an unusual one indeed. Initially marked by nihilism and fear, but benefiting from a remarkable joint effort of human and material resources (multi-center and -institutional research), over a period of 30 years, CRS and HIPEC found their place in the treatment of PM. The next 4 years were dedicated to the refinement of the multimodal treatment, by launching research pathways. In selected patients, with requires training, it demonstrated a significant survival results (similar to the Hepatic Metastases treatment), with acceptable risks and costs. The main debates regarding CRS and HIPEC treatment were based on the oncologists' perspective and the small number of randomized clinical trials. It is important to statement the PM patient has the right to be informed of the existence of CRS and HIPEC, as a real treatment resource, the decision being made by multidisciplinary teams. Core tip: The multimodal treatment of peritoneal metastases (PM), involving cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, has been strenuously achieved over time, but seems to be the best treatment option, for selected cases. This paper addresses data about the multimodal treatment strategy, focused to patient's survival, the key indicator for assessing results, in the case of PM. Also, it were highlighted the treatment key aspects and the controversies, high in the 35 years of treatment implementing. By understanding the philosophy of multimodal treatment, physicians will be able to offer an alternative to the routine systemic chemotherapy.Lungoci C, Mironiuc AI, Muntean V, Oniu T, Leebmann H, Mayr M, Piso P. Multimodality treatment strategies have changed prognosis of peritoneal metastases.

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“…Prophylactic HIPEC in high-risk CRC (pT3/pT4 and mucinous or signet ring cell histology) at the primary resection has been reported by Sammartino et al 5 In their study, peritoneal metastases and local recurrence developed significantly less often in proactively managed patients than in controls (4% vs. 28%; p \ 0.03), and there was significantly longer disease-free and overall survival than in the control group (p \ 0.05 and p \ 0.04). Elias reported similar results with a planned second-look at 6 months in 41 patients with synchronous peritoneal disease, ovarian metastases, or perforation on the primary resection (high-risk).…”

mentioning

confidence: 88%

Reply: “Adjuvant” Hyperthermic Intraperitoneal Chemotherapy: A Call to Action

Morris

2017

Ann Surg Oncol

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Long-term results after proactive management for locoregional control in patients with colonic cancer at high risk of peritoneal metastases

Cited by 57 publications

References 35 publications

Signet ring colorectal carcinoma: Do we need to improve the treatment algorithm?

Signet ring colorectal carcinoma: Do we need to improve the treatment algorithm?

Multimodality treatment strategies have changed prognosis of peritoneal metastases

Reply: “Adjuvant” Hyperthermic Intraperitoneal Chemotherapy: A Call to Action

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