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Intraperitoneal chemotherapy for colorectal cancer
Eelco de Bree1, A J Witkamp, Frans A N Zoetmulder
1Department of Surgical Oncology, The Netherlands Cancer Institute (Antoni van Leeuwenhoek Hospital), Amsterdam, The Netherlands.
Journal of Surgical Oncology
|January 5, 2002
Summary
Intraperitoneal chemotherapy offers a promising treatment for colorectal cancer peritoneal metastases, delivering high drug concentrations locally. Intraoperative chemotherapy with cytoreductive surgery may improve survival in patients with peritoneal carcinomatosis.
Area of Science:
- Oncology
- Surgical Oncology
- Gastroenterology
Background:
- Peritoneal surface disease is a significant failure point in colorectal cancer (CRC) management.
- Peritoneal carcinomatosis (PC) is currently treated with systemic chemotherapy and palliative surgery, yielding limited survival benefits.
- CRC cells exhibit resistance to conventional chemotherapy, necessitating novel therapeutic strategies.
Purpose of the Study:
- To evaluate the efficacy of intraperitoneal chemotherapy (IP) as a treatment for high-risk colorectal cancer and PC.
- To determine if intraoperative IP chemotherapy with cytoreductive surgery improves outcomes compared to systemic approaches.
Main Methods:
- Review of existing literature on IP chemotherapy for CRC and PC.
- Analysis of phase II study results investigating intraoperative IP chemotherapy with mitomycin C (MMC) and cisplatin.
- Emphasis on the role of cytoreductive surgery in conjunction with IP chemotherapy.
Main Results:
- Intraperitoneal chemotherapy provides high local drug concentrations with reduced systemic toxicity.
- Intraoperative IP chemotherapy, combined with extensive cytoreductive surgery, shows potential for increased median survival in phase II studies.
- Postoperative IP chemotherapy demonstrates inadequate peritoneal surface drug exposure.
Conclusions:
- Adjuvant early postoperative IP chemotherapy warrants consideration after resection of high-risk CRC.
- Intraoperative IP chemotherapy with direct cytotoxic agents is crucial for treating PC, overcoming limitations of postoperative administration.
- Randomized controlled trials are necessary to definitively establish the survival benefit of regional treatment for peritoneal dissemination of CRC.