[Principles of the treatment of peritoneal carcinomatosis due to colorectal cancer. Current review and update].
Colorectal cancer is the most frequent digestive tumor. The incidence of abdominal dissemination is high and all studies of the natural history of colorectal carcinomatosis demonstrate that prognosis in these patients is poor, with a mean survival of between 5 and 9 months. Furthermore, the results of systemic adjuvant treatment are disappointing, with a maximum survival of 18 months. Consequently, other treatment strategies need to be studied and developed. We present a review of the principles that underlie Sugarbakers treatment protocol, which includes maximal cytoreductive surgery for the treatment of macroscopic disease through peritonectomy together with perioperative intraperitoneal intensification chemotherapy for residual microscopic disease. We present all the phase II studies with more than 10 treated patients published in the medical literature by the main groups working in this line of treatment, together with the only phase III study published to date. With this new therapeutic alternative, the mean overall survival at 2 and 5 years is 40% and 20% respectively. Based on these results, this new therapeutic approach is recommended as the treatment of choice in these unfortunate patients. The limits of the treatment of advanced colorectal cancer are also discussed.
Gómez-Portilla
Alberto
A
Programa de Carcinomatosis Peritoneal, Servicio de Cirugía, Policlínica San José, Vitoria, Alava, Spain. agomezpor@teleline.es
Cendoya
Iñaki
I
López de Tejada
Iñaki
I
Olabarria
Iñaki
I
Magrach
Luis
L
Martínez de Lecea
Concepción
C
Gil
Alberto
A
Valdovinos
Mercedes
M
Larrabide
Iñaki
I
Ruiz de Alegría
Natalia
N
Fernández
José Luis
JL
Cachorro
Irune
I
Contreras
María del Carmen
Mdel C
Castañeda
Josu
J
Uriarte
Arantxa
A
Boado
María Victoria
MV
Urturi
José Antonio
JA
Ulibarrena
Miguel Angel
MA
D002277:Carcinoma / Q000556:secondary* / Q000628:therapy*; D002986:Clinical Trials as Topic; D015179:Colorectal Neoplasms / Q000473:pathology*; D003131:Combined Modality Therapy; D006801:Humans; D010534:Peritoneal Neoplasms / Q000556:secondary* / Q000628:therapy*