Systemic treatment of patients with metachronous peritoneal carcinomatosis of colorectal origin

Combining chemotherapy and targeted therapies has resulted in an enhanced survival in metastatic colorectal cancer (mCRC) patients. However, the result of this palliative treatment in patients with metachronous peritoneal carcinomatosis (PC) remains unknown. The current population-based study aims to investigate the use and effect of palliative systemic treatment in patients with metachronous PC of colorectal origin. Data on metachronous PC were collected between 2010 and 2011 for all patients who were diagnosed with M0 colorectal cancer between 2003 and 2008 in the Dutch Eindhoven Cancer Registry. Patient demographics and detailed data on chemotherapeutic treatment were collected and compared. Ninety-two patients with metachronous PC received chemotherapy in a palliative setting compared to 94 patients without treatment. In 36 patients, Bevacizumab was added to the treatment (39%). Overall survival was 3.4, 13, and 20.3 months in the no treatment, systemic treatment and systemic treatment + Bevacizumab respectively (P < 0.001). Male gender was a positive predictor and right sided primary tumor location a negative predictor of receiving bevacizumab. Approximately 40% of patients with metachronous PC received bevacizumab in addition to chemotherapy. Treatment with systemic chemotherapy in combination with bevacizumab may increase survival in a patients with metachronous colorectal PC

Clinical experiences with peritoneal carcinomatosis treatment using cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Peritonitis carcinomatosa (PC) is a metastatic disease pattern associated with various types of primary tumours and very low survival rates. Since the combination of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) was introduced in the previous century, patients have been offered a chance of prolonged survival and sometimes recovery, despite the fact that most of them are not eligible for this type of treatment. This dissertation tries to explain the selection of patients with peritoneal cancer of colorectal origin who are eligible for this type of treatment and who are not, thereby showing in which patients this type of treatment is effective and in which patients it is not

Targeting the peritoneum with novel drug delivery systems in peritoneal carcinomatosis: a review of the literature

The Peritoneal cavity is a well-known metastatic site for several intra-abdominal malignancies, such as stomach, colon, pancreas and rectal cancer. For long, it was thought that treatment with curative intent was impossible but that was challenged by the introduction of cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC). Although their effectiveness has been proven both experimentally and clinically, there is need for improvement. Firstly, a significant proportion of patients develop recurrent disease. Secondly, HIPEC demands presence of dedicated perfusion devices not readily available in most hospitals. Since intraperitoneal administration of chemotherapy is thought to play a crucial role, new modalities to deliver effective chemotherapeutics to the peritoneum are developed. The current review aims to present an overview of the experimental data on new drug delivery systems (DDS) in peritoneal cancer