Vallicelli Carlo, Cavaliere Davide, Catena Fausto, Coccolini Federico, Ansaloni Luca, Poiasina Elia, Abongwa Hariscine K, De Simone Belinda, Alberici Laura, Framarini Massimo, Verdecchia Giorgio M
Unit of Surgery and Advanced Oncologic Therapies, Morgagni-Pierantoni Hospital, Forlì, Italy,
Int J Colorectal Dis. 2014 Aug;29(8):895-8. doi: 10.1007/s00384-014-1907-x. Epub 2014 Jun 11.
Today, we do not have a universally accepted evidence on how to treat peritoneal carcinomatosis (PC) from colorectal cancer (CRC) in international guidelines.
The present study is a review of the literature investigating current strategies to treat CRC PC.
Despite the progresses of systemic chemotherapy, the presence of PC among patients with metastatic CRC reduces the overall survival to 30 %, and only 4 % of patients with PC from CRC treated are alive for 5 years. Many trials evaluate the combined treatment of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for CRC PC, suggesting a survival benefit in highly selected patients. Only one trial is randomized and presents some biases. The two main prognostic factors are Peritoneal Cancer Index (PCI) and completeness of cytoreduction score (CC score). There is no universal agreement on how to approach the synchronous presence of PC and liver metastasis with a curative intent during the same procedure. A growing interest among the scientific community has arisen about systematic second-look surgery and HIPEC treatment in high-risk patients.
Current evidences suggest that CRS and HIPEC might be beneficial in highly selected patients affected with PC from CRC. Anyway, today, there is a shortage of well-designed phase 3 trials.
目前，国际指南中对于如何治疗结直肠癌（CRC）所致的腹膜癌（PC）尚无普遍接受的证据。
本研究是一项对探讨CRC所致PC当前治疗策略的文献综述。
尽管全身化疗取得了进展，但转移性CRC患者中PC的存在将总生存率降至30%，且接受治疗的CRC所致PC患者中仅有4%能存活5年。许多试验评估了细胞减灭术（CRS）与腹腔内热灌注化疗（HIPEC）联合治疗CRC所致PC的效果，提示在经过严格筛选的患者中有生存获益。仅有一项试验是随机的且存在一些偏差。两个主要的预后因素是腹膜癌指数（PCI）和细胞减灭评分完整性（CC评分）。对于在同一手术过程中如何以治愈为目的处理PC与肝转移的同时存在，尚无普遍共识。科学界对高危患者的系统性二次探查手术和HIPEC治疗的兴趣日益浓厚。
目前的证据表明，CRS和HIPEC可能对经过严格筛选的CRC所致PC患者有益。无论如何，目前缺乏设计良好的3期试验。
