Abstract
Background: Management of peritoneal metastases from colorectal cancer is a highly debatable subject. Treatment options of this disease range from systemic chemotherapy, surgery followed by chemotherapy to resection, then chemotherapy and intraperitoneal chemotherapy with hyperthermia. Aim of the study: To review guidelines and updated studies on management of peritoneal carcinomatosis caused by colorectal cancer. Methodology: The study includes review of systematic reviews, multi-institutional data collection, randomized controlled trials and clinical reviews. Results: A total number of 893 patients with advanced colon cancer who presented as stage IV with peritoneal metastases as first presentation have been involved in this study. The most significant finding in these studies is the role of systemic chemotherapy either given as neoadjuvant, adjuvant or combined modality. The addition of Bevazucimab as vascular endothelial growth factor (VEGF) was a significant factor in improving response rate and survival. The use of Mitomycin C (MMC) as a component of HIPEC: hyperthermic intraperitoneal chemotherapy) was better than Oxaliplatinin terms of median overall survival. Conclusion: The best treatment strategy for these patients is to give neoadjuvant chemotherapy (no specific regime showed superiority over others) with VEGF Bevazucimab aiming at maximum cytoreduction, and then doing HIPEC using Mitomycin C as chemotherapeutic agent followed by adjuvant chemotherapy including Bevazicumab as VEGF component.
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