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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. Aug 6, 2016; 7(3): 343-352
Published online Aug 6, 2016. doi: 10.4292/wjgpt.v7.i3.343
Therapeutic options for peritoneal metastasis arising from colorectal cancer
Gabriel Glockzin, Hans J Schlitt, Pompiliu Piso
Gabriel Glockzin, Department of Surgery, Staedtisches Klinikum Muenchen GmbH, Klinikum Bogenhausen, 81925 Munich, Germany
Hans J Schlitt, Department of Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
Pompiliu Piso, Department of Surgery, Hospital of the Order of St. John of God, 93049 Regensburg, Germany
Author contributions: Glockzin G drafted the manuscript; Schlitt HJ and Piso P revised the manuscript; all authors read and approved the final manuscript.
Conflict-of-interest statement: All authors declare that they have no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Gabriel Glockzin, MD, FEBS, Department of Surgery, Staedtisches Klinikum Muenchen GmbH, Klinikum Bogenhausen, Englschalkinger Str. 77, 81925 Munich, Germany. gabriel.glockzin@klinikum-muenchen.de
Telephone: +49-89-92702011 Fax: +49-89-92702016
Received: March 29, 2016
Peer-review started: April 4, 2016
First decision: May 17, 2016
Revised: June 22, 2016
Accepted: July 11, 2016
Article in press: July 13, 2016
Published online: August 6, 2016
Processing time: 125 Days and 3.9 Hours
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.