Therapeutic options for peritoneal metastasis arising from colorectal cancer

Abstract

Peritoneal metastasis is a common sign of advanced tumor stage, tumor progression or tumor recurrence in patients with colorectal cancer. Due to the improvement of systemic chemotherapy, the development of targeted therapy and the introduction of additive treatment options such as cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), the therapeutic approach to peritoneal metastatic colorectal cancer (pmCRC) has changed over recent decades, and patient survival has improved. Moreover, in contrast to palliative systemic chemotherapy or best supportive care, the inclusion of CRS and HIPEC as inherent components of a multidisciplinary treatment regimen provides a therapeutic approach with curative intent. Although CRS and HIPEC are increasingly accepted as the standard of care for selected patients and have become part of numerous national and international guidelines, the individual role, optimal timing and ideal sequence of the different systemic, local and surgical treatment options remains a matter of debate. Ongoing and future randomized controlled clinical trials may help clarify the impact of the different components, allow for further improvement of patient selection and support the standardization of oncologic treatment regimens for pmCRC. The addition of further therapeutic options such as neoadjuvant intraperitoneal chemotherapy or pressurized intraperitoneal aerosol chemotherapy, should be investigated to optimize therapeutic regimens and further improve the oncological outcome.

Keywords: Peritoneal metastasis; Colorectal cancer; Systemic chemotherapy; Intraperitoneal chemotherapy; Cytoreductive surgery

Core tip: Beyond diverse systemic, interventional and surgical palliative treatment options for peritoneal metastasis arising from colorectal cancer, the combination of systemic chemotherapy, cytoreductive surgery and hyperthermic intraperitoneal chemotherapy provides a therapeutic approach with curative intent for selected patients. Nevertheless, the treatment regimens, the sequence of therapy and the impact of the different components of the multidisciplinary treatment concept on clinical and oncological outcomes remain a matter of debate. Moreover, the addition of further therapeutic options to the existing treatment regimens might allow for higher complete resection rates and improved survival rates.