Intraperitoneal chemotherapy for prevention and treatment of peritoneal carcinomatosis from colorectal origin

Authors E. de Bree,, F.A.N. Zoetmulder, J. Romanos, A.J. Witkamp, D.D. Tsiftsis.


The peritoneal surface remains an important failure site
for patients with colorectal cancer. Peritoneal metastases
of colorectal cancer are at present considered equal to distant
metastatic disease. Consequently, peritoneal carcinomatosis
is treated with systemic chemotherapy and surgery
only to palliate complications such as obstruction. Despite
the development of new chemotherapeutic agents and combinations,
the results remain disappointing with a limited
impact on survival. Colorectal carcinoma cells are relatively
resistant to chemotherapy. Intraperitoneal chemotherapy
seems to be an attractive approach in the treatment of highrisk
colorectal cancer and peritoneal carcinomatosis of colorectal
origin providing high local drug concentration with
limited systemic side effects. Adjuvant early postoperative
intraperitoneal chemotherapy is worthwhile considering as
a treatment option after resection of high-risk colorectal
cancer. Meta-analysis of randomized trials demonstrates
a positive impact of this adjuvant treatment on overall survival
and regional tumor control. In the treatment of peritoneal
carcinomatosis postoperative intraperitoneal chemotherapy
leads to inadequate exposure of the peritoneal surface.
Only intraoperative continuous peritoneal perfusion
chemotherapy performed with direct cytotoxic drugs such
as MMC and cisplatin may overcome this problem. The limited limited
drug penetration in tissue implies the need for extensive
cytoreductive surgery. Additionally, the latter form of
regional chemotherapy can be performed under hyperthermic
conditions. Hyperthermia has a direct cytotoxic effect
and enhances the activity and penetration depth of many
cytotoxic drugs. The results of phase II studies of cytoreductive
surgery and intraoperative hyperthermic intraperitoneal
chemotherapy for peritoneal carcinomatosis of colorectal
origin suggest that an increased median survival
can be achieved with this approach, especially in patients
with no macroscopic or small volume residual disease.