Canadian guidelines on the management of colorectal peritoneal metastases

A Brind'Amour, P Dubé, J F Tremblay, M L Soucisse, L Mack, A Bouchard-Fortier, J A McCart, A Govindarajan, D Bischof, E Haase, C Giacomantonio, P Hebbard, R Younan, A MacNeill, C Boulanger-Gobeil, L Sidéris, A Brind'Amour, P Dubé, J F Tremblay, M L Soucisse, L Mack, A Bouchard-Fortier, J A McCart, A Govindarajan, D Bischof, E Haase, C Giacomantonio, P Hebbard, R Younan, A MacNeill, C Boulanger-Gobeil, L Sidéris

Abstract

Modern management of colorectal cancer (crc) with peritoneal metastasis (pm) is based on a combination of cytoreductive surgery (crs), systemic chemotherapy, and hyperthermic intraperitoneal chemotherapy (hipec). Although the role of hipec has recently been questioned with respect to results from the prodige 7 trial, the role and benefit of a complete crs were confirmed, as observed with a 41-month gain in median survival in that study, and 15% of patients remaining disease-free at 5 years. Still, crc with pm is associated with a poor prognosis, and good patient selection is essential. Many questions about the optimal management approach for such patients remain, but all patients with pm from crc should be referred to, or discussed with, a pm surgical oncologist, because cure is possible. The objective of the present guideline is to offer a practical approach to the management of pm from crc and to reflect on the new practice standards set by recent publications on the topic.

Keywords: Peritoneal metastases; colorectal cancer; cytoreductive surgery; hyperthermic intraperitoneal chemotherapy; peritoneal carcinomatosis.

Conflict of interest statement

CONFLICT OF INTEREST DISCLOSURES We have read and understood Current Oncology’s policy on disclosing conflicts of interest, and we declare that we have none.

2020 Multimed Inc.

Figures

FIGURE 1
FIGURE 1
Algorithm for acute presentation of peritoneal metastases from colorectal cancer.
FIGURE 2
FIGURE 2
Overall survival in the PRODIGE 7 trial. HIPEC = hyperthermic intraperitoneal chemotherapy.
FIGURE 3
FIGURE 3
Standard management of synchronous isolated peritoneal metastasis (PM). PCI = peritoneal carcinomatosis index; FOLFOX = 5-fluorouracil–leucovorin–oxaliplatin; CAPOX = capecitabine–oxaliplatin; FOLFIRI = 5-fluorouracil–leucovorin–irinotecan; CT = computed tomography; CRS = cytoreductive surgery; HIPEC = hyperthermic intraperitoneal chemotherapy.
FIGURE 4
FIGURE 4
Standard management of metachronous isolated peritoneal metastasis (PM). PET–CT = integrated positron-emission tomography–computed tomography; FOLFOX = 5-fluorouracil–leucovorin–oxaliplatin; CAPOX = capecitabine–oxaliplatin; FOLFIRI = 5-fluorouracil–leucovorin–irinotecan; CRS = cytoreductive surgery; PCI = peritoneal carcinomatosis index; HIPEC = hyperthermic intraperitoneal chemotherapy.
FIGURE 5
FIGURE 5
Standard management of patients with high-risk features for peritoneal recurrence. PM = peritoneal metastasis; FOLFOX = 5-fluorouracil–leucovorin–oxaliplatin; CAPOX = capecitabine–oxaliplatin; CT = computed tomography; HIPEC = hyperthermic intraperitoneal chemotherapy; PCI = peritoneal carcinomatosis index; CRS = cytoreductive surgery.

Source: PubMed

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