Cytoreductive Surgery and Heated Intra-Peritoneal Chemotherapyin the Treatment of Peritoneal Carcinomatosis of Colorectal Origin:The Need for Practice Altering Data

摘要

In patients with unresectable metastatic colorectal cancer (CRC) surgery has been traditionally reserved for palliation of bleeding, obstruction, perforation, and/or intractable pain. For 40 years, treatment with 5-Fluorouracil modulated by Leucovorin or Levamisole has remained fairly constant, and median overall survival of patients with advanced CRC treated with this regimen has remained ~12 months. However, over this period of time, our ability to select patient subsets with limited hepatic, even pulmonary, metastasis that could benefit from surgical resection has improved considerably. Contemporary systemic therapy regimens incorporating both cytotoxic chemother-apeutic and biological agents have led to unsurpassed improvements in survival (median ~20 months) for patients with advanced CRC . Evidence-based practice management and quality improvement through consensus-driven treatment decision-making algorithms and clinical pathways have ushered into modern-day practice neoadjuvant protocols including multi-drug systemic therapy and interventional radiology procedures that enable staged liver resections for CRC metastases. These interventions have increased significantly the number of patients that are suitable candidates for surgical eradication of metastatic disease to the liver and offer some patients previously considered incurable a chance for cure. These data emphasize the imperative of multi-disciplinary treatment planning and delivery of quality cancer care through a working partnership of medical and surgical oncologists.