Treatment of Peritoneal Carcinomatosis From Colorectal Cancer: Impact of Complete Cytoreductive Surgery and Difficulties in Conducting Randomized Trials

Abstract

This supports the use of complete cytoreductive surgery in selected patients and calls for a prospective randomized trial comparing adjuvant systemic chemotherapy with intraperitoneal chemohyperthermia after complete resection.

Cytoreductive surgery and intraperitoneal chemotherapy for colorectal peritoneal carcinomatosis: Prognosis and treatment of recurrences in a cohort study

“…Further randomised trials between systemic chemotherapy and CRS with IPC may be difficult to conduct at this stage, which has also been demonstrated by an earlier failed randomised trial between systemic chemotherapy and CRS with EPIC. [5] It appears more important to develop a standardised patient selection protocol. The number of "open and close" cases needs to be decreased as their survival is particularly dismal (median OS 6.5 months) and a full laparotomic exploration may actually put them in a worse position than having gone directly to palliative systemic chemotherapy.…”

“…[1][2][3][4][5][6] Concerning comparative studies, the method mainly investigated is intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) revealing significant improvement over systemic chemotherapy alone in one randomised and two case control trials. [1][2][3] Early postoperative intraperitoneal chemotherapy (EPIC) and sequential postoperative intraperitoneal chemotherapy (SPIC) have also been investigated against systemic chemotherapy.…”

“…[1][2][3] Early postoperative intraperitoneal chemotherapy (EPIC) and sequential postoperative intraperitoneal chemotherapy (SPIC) have also been investigated against systemic chemotherapy. [4][5][6] There are three multi-institutional observational IPC studies published: two French studies with 506 and 523 patients and one Italian study with 146 patients. [7][8][9] Additionally, two other observational studies are published with more than 100 patients.…”

Peritoneal Carcinomatosis

“…This trial recently closed, failing to meet accrual and amplifying the concerning from Elias et al [122] about the feasibility of this kind of studies: basically, even if few trials are active nowadays (in particular the last could be the PRODIGE 7 French trial [124] , with 150/280 patients enrolled at January 2012), the idea to get a level of evidence Ⅰa/Ⅰb in support of HIPEC for PCCRC is near to be abandoned.…”

Neoadjuvant intraperitoneal chemotherapy with paclitaxel for the radical surgical treatment of peritoneal carcinomatosis in ovarian cancer: a prospective pilot study

“…However, the associated morbidity of EPIC in colorectal carcinomatosis observed by Elias et al [5] has limited its use. The intraperitoneal chemotherapy administration in advanced ovarian cancer has also been administered during the late postoperative phase.…”