Hyperthermic Intraperitoneal Chemotherapy (HIPEC) and Cytoreductive Surgery (CRS) for Colorectal Cancer: Potential for Individualized Care, Review of Current Treatment Trends, Recent Advancements, and a Look into the Future

AbstractPurpose of ReviewPeritoneal metastases (PM) secondary to colorectal cancer is associated with a poor prognosis. However, cytoreductive surgery with hyperthermia intraperitoneal chemotherapy (CRS/HIPEC) has risen to a more accepted roll in the treatment of peritoneal metastatic disease for various cancers; colorectal cancer is no exception. This review aims to discuss the recent updates and findings for treatment of peritoneal disease secondary to colorectal cancer, especially with respect to individualized patient factors that affect outcomes.Recent FindingsThere are many new studies showing the validity of cytoreductive surgery CRS/HIPEC in a select group of patients with PM. Many studies show that lower peritoneal cancer index score, use of various chemotherapeutic regimens, histology, preoperative health status, adequate nutrition, and other factors all benefit survival/treatment of this unique patient group.SummaryCurrent evidence supports an aggressive multidisciplinary approach to peritoneal disease secondary to colorectal cancer. Standardized treatment practice, highly selective patient criteria, low PCI score, and early recognition of patients at risk for PM show survival benefits and better outcomes for patients with a disease process that was once only treated with palliative interventions.
Source: Current Colorectal Cancer Reports - Category: Cancer & Oncology Source Type: research

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CONCLUSIONS: PIPAC offers a novel treatment option for patients with PM. Our data show that PIPAC is safe and well-tolerated. Ascites production can be controlled by PIPAC in patients with intestinal cancer. Further studies are required to document the significance of PIPAC within palliative therapy concepts. TRIAL REGISTRATION: NCT03100708. PMID: 31469058 [PubMed - as supplied by publisher]
Source: Tumori - Category: Cancer & Oncology Tags: Tumori Source Type: research
This study describes the pattern of referral and outcomes of patients managed through one UK centre.Methodsand Methods: A prospective register recorded referrals, demographics, prior treatment pathways, and specialist multidisciplinary team (MDT) decisions (2002-2015). Peritoneal cancer index (PCI) was recorded intra-operatively; complete cytoreduction was deemed when a CC0/1 was achieved. Complications were classified using NCI CTCAE. v.4. Median overall survivals (OS) were described for those treated by CRS/HIPEC and in derived estimates for patients with isolated peritoneal metastases treated by chemotherapy alone in th...
Source: European Journal of Surgical Oncology (EJSO) - Category: Surgery Source Type: research
Publication date: Available online 21 December 2018Source: European Journal of Surgical OncologyAuthor(s): Nadine L. de Boer, Jan A.W. Hagemans, Bob T.A. Schultze, Alexandra R.M. Brandt-Kerkhof, Eva V.E. Madsen, Cornelis Verhoef, Jacobus W.A. BurgerAbstractIntroductionPatients with peritoneal carcinomatosis who do not have curative treatment options often develop acute obstructive symptoms and when conservative management fails, surgical treatment is the remaining option. However, palliative surgery is associated with high morbidity and mortality and the chance of success is unclear. The aim of this study was to evaluate o...
Source: European Journal of Surgical Oncology (EJSO) - Category: Surgery Source Type: research
This article reviews and highlights the recent evidence of CRS and HIPEC as well as current research going on in this form of locoregional treatment in the setting of peritoneal metastases of colorectal cancer.
Source: Current Treatment Options in Oncology - Category: Cancer & Oncology Source Type: research
ConclusionThe findings show that CRS and HIPEC results in prolonged survival for selected patients with colorectal peritoneal carcinomatosis and a lower cost per life year attained than for the traditionally used palliative chemotherapy. It should logically be the preferred treatment of choice for selected patients with colorectal peritoneal metastasis.
Source: Annals of Surgical Oncology - Category: Cancer & Oncology Source Type: research
This study aimed to evaluate the management of isolated peritoneal recurrence after primary CRS-HIPEC.MethodsIn two tertiary referral centers, all patients who underwent CRS-HIPEC for colorectal PC between 2004 and 2015 and who developed isolated peritoneal recurrences were retrospectively evaluated. Location, treatment of peritoneal recurrences, and curative or palliative treatment intent were reported, and univariable and multivariable Cox regression analysis and survival analyses were performed.ResultsOf 414 patients treated with CRS-HIPEC for colorectal PC, 106 patients (26%) developed isolated peritoneal recurrence. F...
Source: Annals of Surgical Oncology - Category: Cancer & Oncology Source Type: research
This study aimed to evaluate the management of isolated peritoneal recurrence after primary CRS-HIPEC. METHODS: In two tertiary referral centers, all patients who underwent CRS-HIPEC for colorectal PC between 2004 and 2015 and who developed isolated peritoneal recurrences were retrospectively evaluated. Location, treatment of peritoneal recurrences, and curative or palliative treatment intent were reported, and univariable and multivariable Cox regression analysis and survival analyses were performed. RESULTS: Of 414 patients treated with CRS-HIPEC for colorectal PC, 106 patients (26%) developed isolated peritone...
Source: Ann Oncol - Category: Cancer & Oncology Authors: Tags: Ann Surg Oncol Source Type: research
AbstractPeritoneal carcinomatosis (PC) from colorectal cancer (CRC) is a disease with a poor prognosis, often thought to be a terminal illness with no hope except for palliative treatment. New therapeutic modalities combining cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have shown favorable outcomes and may provide a significant survival benefit in a selected group of patients. The main rational for CRS is to remove all visible tumor burden to allow for the chemotherapeutic agent (HIPEC) to eradicate any microscopic residual disease. The Amsterdam statement formulated at the 9th Interna...
Source: Current Colorectal Cancer Reports - Category: Cancer & Oncology Source Type: research
Authors: Mo S, Cai G Abstract Peritoneum is one of the common sites of metastasis in advanced stage colorectal cancer patients. Colorectal cancer patients with peritoneal metastases (PM) are traditionally believed to have poor prognosis, which indicates it is of no value to adopt surgical treatment. With the advancement of surgical techniques, hyperthermic intraperitoneal chemotherapy (HIPEC), and multidisciplinary treatment in recent years, the cognition and treatment strategies of colorectal peritoneal metastases (CPM) have changed dramatically. In terms of prognosis, CPM under the palliative systemic treatment s...
Source: Gastroenterology Research and Practice - Category: Gastroenterology Tags: Gastroenterol Res Pract Source Type: research
ConclusionsOur study shows that good results may be achieved in terms of symptom palliation and improvement of quality of life in very advanced cancer patients with MA from PC. The treatment was generally well tolerated considering the limited treatment options available for these patients.
Source: Supportive Care in Cancer - Category: Cancer & Oncology Source Type: research
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