Strategies for the prevention and treatment of peritoneal carcinomatosis from gastrointestinal cancer.
BACKGROUND
Peritoneal surface malignancy can result from full thickness invasion of gastrointestinal cancer through the bowel wall or from dissemination of cancer cells from the trauma of cancer surgery. In the past, this clinical situation was treated only with palliative intent.


METHODS
An aggressive approach to peritoneal surface malignancy involves peritonectomy procedures, perioperative intraperitoneal chemotherapy and knowledgeable patient selection. The clinical assessments necessary for valid clinical judgements include the cancer histopathology (invasive vs. expansive progression), the preoperative abdominal and pelvic CT, the peritoneal cancer index and the completeness of cytoreduction score. Proper patient selection is mandatory for optimizing the results of treatment.


RESULTS
In a series of phase II studies, appendiceal tumors with peritoneal seeding became the paradigm for success with an 85% long-term survival in selected patients. Carcinomatosis from colon cancer had an overall 5-year survival of 50% with selected patients. In all malignancies, early aggressive treatment of minimal peritoneal surface dissemination showed the greatest benefit.


CONCLUSIONS
Oncologists must accept responsibility for knowledgeable management of peritoneal surface dissemination of cancer because a curative approach has been demonstrated in both phase II studies and phase III studies. All historical controls show 0% long-term survival. Surgical interventions combined with perioperative intraperitoneal chemotherapy in diseases where peritoneal surface spread occurs must be considered a treatment option.
Sugarbaker
Paul H
PH
Washington Cancer Institute, Washington, District of Columbia 20010, USA. Paul.Sugarbaker@medstar.net
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002277:Carcinoma / Q000188:drug therapy* / Q000517:prevention & control* / Q000601:surgery; D003110:Colonic Neoplasms / Q000473:pathology* / Q000601:surgery; D005770:Gastrointestinal Neoplasms / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007263:Infusions, Parenteral; D007432:Intraoperative Period; D009361:Neoplasm Invasiveness; D009360:Neoplastic Cells, Circulating; D018579:Patient Selection; D010534:Peritoneal Neoplasms / Q000188:drug therapy* / Q000517:prevention & control* / Q000601:surgery; D011379:Prognosis