Colorectal cancer (CRC) often presents with peritoneal metastases, which have a poor outcome. This means that cancer cells have spread from the colon, appendix, or rectum to the peritoneum (a sheath that covers the abdominal organs). This article argues the pros and cons of a combined treatment for patients with peritoneal metastases from CRC. This therapy includes cytoreductive surgery or debulking (removal of parts of a cancer that cannot be completely excised) followed by hyperthermic perioperative chemotherapy or HIPEC (after cancer is removed, the abdominal cavity is washed with a warm solution of chemotherapy).
Surgery is effective for CRC patients with peritoneal metastases if all visible cancerous tissue can be removed (complete cytoreduction). The HIPEC is meant to complete the eradication of cancer cells could not be surgically removed. Young and fit patients have a better chance of success due to the high risks of this procedure. On the other hand, peritoneal metastases progress rapidly, and an early treatment limits the extent of the disease.
Compared to chemotherapy with modern medicines alone, debulking plus HYPEC has proven a higher survival rate. Still, the clinical data gathered on this subject is not enough to form a definite conclusion.
In summary, studies have proven the efficacy of this combined treatment on a selected group of CRC patients with peritoneal metastases. However, peritoneal metastases have a poor outcome, the surgery needed has great risks and the warmed chemotherapy has many side-effects. Due to these arguments, the risks and side-effects of this procedure should be weighed carefully against its benefit for each individual patient.
Published By :
Lancet oncology
Date :
Aug 01, 2012
