Peritoneal carcinomatosis of colorectal origin. Current treatment. Review and update.
Colorectal cancer is the most frequent tumor of the digestive tract. The high incidence of abdominal dissemination; the poor prognosis of these patients, with median survival consistently ranging from 5 to 9 months in all studies of peritoneal carcinomatosis from colorectal cancer; the failure of adjuvant systemic chemotherapy treatment with a maximal survival of 18 months despite the development of new cytostatic drugs, and new combinations of use, make it crucial to search for and develop new treatment strategies. We review the principles of Sugarbaker s treatment protocol, which involves the combination of maximum cytoreductive radical oncological surgery for the treatment of all macroscopically disseminated disease with maximum perioperative intraperitoneal intensification chemotherapy to treat residual microscopic disease. We present the results of several scientific papers, all of them phase II studies with more than 10 patients treated, published in the medical literature by the main groups working in this line of treatment, together with the only phase III study reported and published so far, and finally the results of a recently reported retrospective international multicenter study. With this new alternative therapeutic approach, overall mean survival is 40% at 36 months, and 20% at 5 years. Based on these results, this new therapeutic approach is proposed as the treatment of choice for these unfortunate patients.
Gómez Portilla
A
A
Peritoneal Carcinomatosis Programme, Policlínica San José, Vitoria, Spain. agomezpor@teleline.es
Cendoya
I
I
López de Tejada
I
I
Olabarría
I
I
Martínez de Lecea
C
C
Magrach
L
L
Gil
A
A
Echevarría
J
J
Valdovinos
M
M
Larrabide
I
I
D000970:Antineoplastic Agents / Q000008:administration & dosage; D017024:Chemotherapy, Adjuvant; D002985:Clinical Protocols; D002986:Clinical Trials as Topic; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000628:therapy*; D006801:Humans; D006979:Hyperthermia, Induced; D007263:Infusions, Parenteral; D007432:Intraoperative Period; D010534:Peritoneal Neoplasms / Q000556:secondary* / Q000628:therapy*
D000970:Antineoplastic Agents