Multimodality treatment strategies have changed prognosis of peritoneal metastases.

Corneliu Lungoci

doi:10.4251/wjgo.v8.i1.67

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.

Highlights

Peritoneal metastases (PM) were described by Sampson et al[1] (1931) in an ovarian cancer patient
Marked by nihilism and fear, but benefiting from a remarkable joint effort of human and material resources, over a period of 30 years, cytoreductive surgery (CRS)-hyperthermic intraperitoneal chemotherapy (HIPEC) found its place in the multimodal treatment of peritoneal metastases (PM)
CRS-HIPEC opens a lot of new opportunities with reference to the patients’ selection and adopted methodology of this multimodal treatment

Summary

INTRODUCTION

Peritoneal metastases (PM) were described by Sampson et al[1] (1931) in an ovarian cancer patient. The initiator was Verwaal (2003)[35], who carried out a randomized clinical trial for patients with colorectal PM He showed that, during a mean follow-up of 21.6 mo, the MS of patients treated with CRS-HIPEC (22.3 mo) was significantly (P < 0.032) improved compared to patients treated with palliative surgery and systemic chemotherapy with fluorouracil-leucovorin (12.6 mo) (Figure 4A). In addition to randomized clinical trials (the gold standard in the treatment implementation), there are a series of multi-center studies showing survival results for patients treated with CRS-HIPEC. All these studies (numerous and enrolling an incr eased number of patients) shows joint international efforts to identify the role of CRS-HIPEC in multimodal PM treatment They have allowed the development of an important medical database which, by confirming the higher results in terms of survival and disease-free survival, upholds this treatment strategy. PM treatment “Conventional” systemic chemotherapy “Dedicated” intraperitoneal treatment - Palliative treatment “Dedicated” intraperitoneal treatment - Multimodal radical treatment Multimodal radical treatment - confirmation, aspects, patient selection, controversies

Peritonectomy procedures Define PCI and CCRS

Findings

CONCLUSION