Treatment of peritoneal carcinomatosis from colorectal cancer: impact of complete cytoreductive surgery and difficulties in conducting randomized trials.
BACKGROUND
Colorectal peritoneal carcinomatosis (PC) is a frequent and very lethal event. However, cure may be possible with maximal cytoreductive surgery associated with early postoperative intraperitoneal chemotherapy (EPIC).


METHODS
Between 1996 and 2000, we conducted a two-center prospective randomized trial comparing EPIC plus systemic chemotherapy with systemic chemotherapy alone, both after complete cytoreductive surgery of colorectal PC. Only 35 patients could be included among the 90 who were theoretically required, mainly because of patient dissatisfaction with the inclusion criteria. For this reason, the trial was stopped prematurely.


RESULTS
Analysis of these 35 patients showed that complete resection of PC resulted in a 2-year survival rate of 60%-far above the classic 10% survival rate among patients with colorectal PC treated with systemic chemotherapy and symptomatic surgery. In this small series, EPIC did not demonstrate any advantage for survival.


CONCLUSIONS
This supports the use of complete cytoreductive surgery in selected patients and calls for a prospective randomized trial comparing adjuvant systemic chemotherapy with intraperitoneal chemohyperthermia after complete resection.
Elias
Dominique
D
Department of Surgery, Institut Gustave Roussy, Villejuif, France. elias@igr.fr.
Delperro
Jean-Robert
JR
Sideris
Lucas
L
Benhamou
Ellen
E
Pocard
Marc
M
Baton
Olivier
O
Giovannini
Marc
M
Lasser
Philippe
P
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D002277:Carcinoma / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D004608:Eligibility Determination; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D007263:Infusions, Parenteral; D002955:Leucovorin / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010534:Peritoneal Neoplasms / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery*; D011446:Prospective Studies; D016019:Survival Analysis
D002955:Leucovorin; D005472:Fluorouracil