Multimodality treatment strategies have changed prognosis of peritoneal metastases

Abstract

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.

Cytoreductive surgery and intraperitoneal chemotherapy for peritoneal carcinomatosis of colorectal cancer: 2-year follow-up results at a single institution in Korea

“…Metachronous peritoneal metastasis is detected in 50% of patients with recurrent colorectal cancer after curative resection. About 10%–35% of recurrence is found in a form of solitary peritoneal metastasis without any evidence of metastasis to other organs [ 1 2 3 4 ]. Even though peritoneal metastasis is one of the most common forms of colon cancer metastasis, its prognosis is extremely poor with a mean life expectancy of only 6 months.…”

“…Even though peritoneal metastasis is one of the most common forms of colon cancer metastasis, its prognosis is extremely poor with a mean life expectancy of only 6 months. Up until now, mainstream treatment standard for patients with PC is limited to systemic chemotherapy that shows minimal efficacy due to poor vascular anatomical character of peritoneum [ 1 2 3 4 ].…”

“…Such multimodality therapy has demonstrated the best results for PC through many studies, and some countries have adopted the combination of CRS and hyperthermic intraperitoneal chemotherapy (HIPEC) in official treatment guidelines for colorectal cancer patients with PC. Nevertheless, it has not been universally embraced by the medical community, and most hospitals in Korea do not practice CRS and IPC [ 1 2 3 4 ]. We started CRS and IPC from early 2000, and the case number was increased from end of 2011.…”

Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for peritoneal malignancy: preliminary results of a multi-disciplinary teamwork model in Asia

“…However, only individual surgeons or small surgical teams practice CRS/HIPEC in these hospitals, and it is still an unfamiliar surgical procedure in Taiwan. Multi-disciplinary teamwork (MDT) for CRS/HIPEC has been suggested to improve complication and survival rates [14]; however an established MDT model in a new CRS/HIPEC programme is uncommon.…”

Intraperitoneal Glucose Transport to Micrometastasis: A Multimodal In Vivo Imaging Investigation in a Mouse Lymphoma Model

“…In addition, these findings may be extended to other malignancies with a more frequent occurrence of peritoneal metastases or extranodal manifestations in the abdominal cavity during the course of the disease. The detection of peritoneal metastases at an early stage could be a key component of effective therapy for these diseases [ 17 , 18 ].…”