Current status and future directions: management of colon cancer with peritoneal dissemination

Colorectal cancer is one of the most common cancers worldwide, and although it carries a favorable prognosis when detected at early stages, it is associated with limited survival when metastatic disease is present. Modern systemic therapy has improved median survival in those patients with hematogenous dissemination, but the role of these newer combinations of cytotoxic chemotherapy and biological agents remains undefined in patients with peritoneal carcinomatosis. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy have resulted in long-term good outcomes for patients whose carcinomatosis can be completely removed, but offers no advantage over supportive care for those patients with incomplete tumor removal. At the present time, we lack proven therapeutic strategies on how to treat a patient newly diagnosed with peritoneal carcinomatosis of colorectal origin. A large Phase III multi-institutional trial is being developed to address these issues, and will need full collaboration between medical and surgical oncologists.